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NPI Code Detail

MEDICARE: MS. JACQUELINE CORDERO DPT

MEDICARE: MS. JACQUELINE CORDERO DPT
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
1225100000XPhysical Therapist0330711NY

General Provider Information

NPI Number : 1578870689
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE CORDERO DPT
Provider Business Mailing Address
First Line : 6058 68TH AVE
Second Line :
City : RIDGEWOOD
State : NY
Zip : 11385-4553
Country : US
Telephone Number : 718-964-8246
Fax Number :
Provider Business Practice Location Address
First Line : 361 E 19TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10003-2888
Country : US
Telephone Number : 212-721-5220
Fax Number : 212-982-9816
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2010
Last Update Date : 09/17/2010

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