MEDICARE: PROF. FARICA TERRY BIALSTOCK PT

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	62 005769	NY

General Provider Information

NPI Number	:	1528277704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. FARICA TERRY BIALSTOCK PT

Provider Business Mailing Address
First Line	:	4 JEROLD ST
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3712
Country	:	US
Telephone Number	:	516-572-7552
Fax Number	:	516-572-7565

Provider Business Practice Location Address
First Line	:	1 EDUCATION DR
Second Line	:	NASSAU COMMUNITY COLLEGE
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6719
Country	:	US
Telephone Number	:	516-572-7552
Fax Number	:	516-572-7565

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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