MEDICARE: MRS. NIAMH MARIA LANGELLA BSC(HONS)

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	019872	NY

General Provider Information

NPI Number	:	1518087196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIAMH MARIA LANGELLA BSC(HONS)

Provider Business Mailing Address
First Line	:	40 MARKET ST
Second Line	:
City	:	BREEZY POINT
State	:	NY
Zip	:	11697-1217
Country	:	US
Telephone Number	:	718-318-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	10322 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2744
Country	:	US
Telephone Number	:	718-318-8550
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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