MEDICARE: MR. MATTHEW BATTINELLI P.T.

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	2251N0400X	Neurology Physical Therapist	019367-1	NY
2	2251P0200X	Pediatric Physical Therapist	019367-1	NY
3	2251X0800X	Orthopedic Physical Therapist	019367-1	NY

General Provider Information

NPI Number	:	1538466487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW BATTINELLI P.T.

Provider Business Mailing Address
First Line	:	164 CONSTANT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-2366
Country	:	US
Telephone Number	:	917-881-9818
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 DURANT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3030
Country	:	US
Telephone Number	:	718-987-8020
Fax Number	:

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

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	02/11/2011

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