MEDICARE: HAZEL KATHERINE STO TOMAS DPT

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	225100000X	Physical Therapist	026880	NY

General Provider Information

NPI Number	:	1275808107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEL KATHERINE STO TOMAS DPT

Provider Business Mailing Address
First Line	:	38 DEERFIELD ST
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1805
Country	:	US
Telephone Number	:	201-968-6112
Fax Number	:	201-561-0158

Provider Business Practice Location Address
First Line	:	1980 AMSTERDAM AVE
Second Line	:	UNIT 1B
City	:	NEW YORK
State	:	NY
Zip	:	10032-5058
Country	:	US
Telephone Number	:	212-740-2049
Fax Number	:	201-561-0158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2012
Last Update Date	:	11/30/2021

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