MEDICARE: MR. BENJAMIN GABIONZA 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	024188-1	NY

General Provider Information

NPI Number	:	1356616585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN GABIONZA PT

Provider Business Mailing Address
First Line	:	23102 67TH AVE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-2706
Country	:	US
Telephone Number	:	718-423-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	23102 67TH AVE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-2706
Country	:	US
Telephone Number	:	718-423-8747
Fax Number	:

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

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	03/21/2012

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