MEDICARE: MISS MARY ELAINE E BUENCONSEJO 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	023922-1	NY

General Provider Information

NPI Number	:	1568477081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY ELAINE E BUENCONSEJO PT

Provider Business Mailing Address
First Line	:	15 PARK ROW
Second Line	:	#15J
City	:	NEW YORK
State	:	NY
Zip	:	10038-2301
Country	:	US
Telephone Number	:	212-571-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 JOHN ST
Second Line	:	SUITE 1445
City	:	NEW YORK
State	:	NY
Zip	:	10038-3101
Country	:	US
Telephone Number	:	212-571-4800
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/06/2012

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