MEDICARE: MISS EIDILEEN GITALAN PT

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	024236-01	NY

General Provider Information

NPI Number	:	1306590187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EIDILEEN GITALAN PT

Provider Business Mailing Address
First Line	:	8524 110TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-1244
Country	:	US
Telephone Number	:	347-819-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	8524 110TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-1244
Country	:	US
Telephone Number	:	347-819-1160
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/19/2022

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Directions to “ MISS EIDILEEN GITALAN PT” Practice Location

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