MEDICARE: LILLIAN ALBERT-GARDNER 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	028680-1	NY

General Provider Information

NPI Number	:	1528375730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN ALBERT-GARDNER PT

Provider Business Mailing Address
First Line	:	1 COVENT AVENUE
Second Line	:	APT. 53
City	:	NEW YORK
State	:	NY
Zip	:	10027
Country	:	US
Telephone Number	:	413-454-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 E 19TH ST # 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-2888
Country	:	US
Telephone Number	:	212-721-5220
Fax Number	:

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

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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