MEDICARE: QUEENSBORO PHYSICAL THERAPY OF SOUTH OZONE PARK, PC

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	5334	NY

General Provider Information

NPI Number	:	1487708707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEENSBORO PHYSICAL THERAPY OF SOUTH OZONE PARK, PC

Provider Business Mailing Address
First Line	:	11420 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-1912
Country	:	US
Telephone Number	:	718-845-4616
Fax Number	:	718-845-1965

Provider Business Practice Location Address
First Line	:	11420 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-1912
Country	:	US
Telephone Number	:	718-845-4616
Fax Number	:	718-845-1965

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NICHOLAS F ORICCHIO
Credential	:	R.P.T.
Telephone Number	:	718-845-4616

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/06/2025

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