MEDICARE: MRS. SHARON ROSE SARABOSING KWAN P.T.

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	027286-1	NY

General Provider Information

NPI Number	:	1285688390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON ROSE SARABOSING KWAN P.T.

Provider Business Mailing Address
First Line	:	3552 71ST ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3941
Country	:	US
Telephone Number	:	718-505-0580
Fax Number	:	718-505-0580

Provider Business Practice Location Address
First Line	:	1841 BROADWAY
Second Line	:	SUITE 609
City	:	NEW YORK
State	:	NY
Zip	:	10023-7603
Country	:	US
Telephone Number	:	212-262-4479
Fax Number	:	212-262-4487

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	03/08/2012

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