MEDICARE: DR. JOSHUA D. KERLAN D.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	016517-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00156950	OTHER	NY	PALMETTO GBA
2	200353350	OTHER	NY	UNITED HEALTHCARE
3	5375113	OTHER	NY	AETNA
4	7702607	OTHER	NY	MVP
5	810771	OTHER	NY	EMPIRE PLAN
6	P010016517	OTHER	NY	BLUE CHOICE
7	104539FT	OTHER	NY	PREFERRED CARE
8	P020016517	OTHER	NY	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1417953910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA D. KERLAN D.P.T.

Provider Business Mailing Address
First Line	:	515 WEST WASHINGTON STREET
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456
Country	:	US
Telephone Number	:	315-781-1010
Fax Number	:	315-781-1722

Provider Business Practice Location Address
First Line	:	515 WEST WASHINGTON STREET
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456
Country	:	US
Telephone Number	:	315-781-1010
Fax Number	:	315-781-1722

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/21/2013

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