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NPI Code Detail

MEDICARE: MAIDY JOCELYN VEGA GARCIA PTA

MEDICARE: MAIDY JOCELYN VEGA GARCIA PTA
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
1225200000XPhysical Therapy Assistant011430-1NY

General Provider Information

NPI Number : 1295296911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAIDY JOCELYN VEGA GARCIA PTA
Provider Business Mailing Address
First Line : 2439 27TH ST APT 3A
Second Line :
City : ASTORIA
State : NY
Zip : 11102-2368
Country : US
Telephone Number : 201-660-0485
Fax Number :
Provider Business Practice Location Address
First Line : 150 W END AVE APT 1M
Second Line :
City : NEW YORK
State : NY
Zip : 10023-5715
Country : US
Telephone Number : 212-600-4781
Fax Number : 800-655-3780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2019
Last Update Date : 03/26/2019

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