MEDICARE: MICHAEL FOX 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	0126141	NY

General Provider Information

NPI Number	:	1588613053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FOX PT

Provider Business Mailing Address
First Line	:	26 FIREMENS MEMORIAL DRIVE
Second Line	:	STE 115
City	:	POMONA
State	:	NY
Zip	:	10970-0460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 E 56TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3609
Country	:	US
Telephone Number	:	212-355-7827
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	10/01/2007

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Directions to “ MICHAEL FOX PT” Practice Location

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