MEDICARE: LOUIS NICHOLAS IANNUZZI 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	0070521	NY

General Provider Information

NPI Number	:	1437464930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS NICHOLAS IANNUZZI PT

Provider Business Mailing Address
First Line	:	380 2ND AVE
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10010-5615
Country	:	US
Telephone Number	:	646-387-6838
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 UPTON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3107
Country	:	US
Telephone Number	:	646-387-6838
Fax Number	:

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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