MEDICARE: CHRISTIAN DALE MARQUEZ CORTES

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	045649	NY

General Provider Information

NPI Number	:	1447027065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN DALE MARQUEZ CORTES

Provider Business Mailing Address
First Line	:	3224 GRAND CONCOURSE APT BA
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1067
Country	:	US
Telephone Number	:	917-801-1755
Fax Number	:	917-801-1756

Provider Business Practice Location Address
First Line	:	3224 GRAND CONCOURSE APT BA
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1067
Country	:	US
Telephone Number	:	917-801-1755
Fax Number	:	917-801-1756

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	03/10/2026

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