MEDICARE: NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC

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	009815-1	NY

General Provider Information

NPI Number	:	1487639993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	8 LONG POND RD
Second Line	:
City	:	WACCABUC
State	:	NY
Zip	:	10597-1013
Country	:	US
Telephone Number	:	914-763-0068
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 302
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	914-279-5550
Fax Number	:	914-279-3490

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. JOHANNA ELIZABETH LUBBE
Credential	:	BSC.PHYS.HONS.
Telephone Number	:	845-279-5550

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	08/22/2020

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