MEDICARE: NICHOLAS GARYFALLOS M.S.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	011616	NY

General Provider Information

NPI Number	:	1306903257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS GARYFALLOS M.S.P.T.

Provider Business Mailing Address
First Line	:	3201 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4236
Country	:	US
Telephone Number	:	718-382-9505
Fax Number	:	718-382-9527

Provider Business Practice Location Address
First Line	:	3201 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4236
Country	:	US
Telephone Number	:	718-382-9505
Fax Number	:	718-382-9527

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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