MEDICARE: ROMAN ALLAN SAMSON SOTELO R.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	028622	NY

General Provider Information

NPI Number	:	1295059061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN ALLAN SAMSON SOTELO R.P.T.

Provider Business Mailing Address
First Line	:	3023 23RD ST
Second Line	:	APARTMENT 3
City	:	ASTORIA
State	:	NY
Zip	:	11102-3327
Country	:	US
Telephone Number	:	909-992-2152
Fax Number	:	134-762-1452

Provider Business Practice Location Address
First Line	:	1070 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5310
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	914-530-2161

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

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	04/18/2018

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