MEDICARE: STANLEY JASON GROMELSKI PHYSICAL THERAPIST

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	022090	NY

General Provider Information

NPI Number	:	1598713323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY JASON GROMELSKI PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	2 W 45TH ST
Second Line	:	SUITE 208
City	:	NEW YORK
State	:	NY
Zip	:	10036-4212
Country	:	US
Telephone Number	:	212-840-6652
Fax Number	:	212-840-6022

Provider Business Practice Location Address
First Line	:	2 W 45TH ST
Second Line	:	SUITE 208
City	:	NEW YORK
State	:	NY
Zip	:	10036-4212
Country	:	US
Telephone Number	:	212-840-6652
Fax Number	:	212-840-6022

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/18/2009

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