MEDICARE: H&D PHYSICAL THERAPY & OCCUPATIONAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1779725	OTHER	NY	UNITED HEALTHCARE
2	7510226	OTHER		AETNA

General Provider Information

NPI Number	:	1235174228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H&D PHYSICAL THERAPY & OCCUPATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	815 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-4503
Country	:	US
Telephone Number	:	212-499-0876
Fax Number	:	212-953-1353

Provider Business Practice Location Address
First Line	:	815 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-4503
Country	:	US
Telephone Number	:	212-499-0848
Fax Number	:	212-753-0713

Authorized Official
Title or Position	:	BC ACCOUTNS MANAGER
Name	:	SVETLANA SHAGABAYEVA
Credential	:
Telephone Number	:	212-499-0876

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/31/2020

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