MEDICARE: SUE YOUNG CARMOUCHE MSPT

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	020878	NY

General Provider Information

NPI Number	:	1508917741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE YOUNG CARMOUCHE MSPT

Provider Business Mailing Address
First Line	:	345 CLINTON AVE APT 14B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-1122
Country	:	US
Telephone Number	:	347-885-3324
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 MALCOLM X BLVD
Second Line	:	RM #3137
City	:	NEW YORK
State	:	NY
Zip	:	10037-1802
Country	:	US
Telephone Number	:	212-939-4442
Fax Number	:	212-939-4446

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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Directions to “ SUE YOUNG CARMOUCHE MSPT” Practice Location

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