MEDICARE: MRS. MEHRBANOO MEHRROSTAMI 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	225100000X	Physical Therapist	022651	NY
2	2251E1200X	Ergonomics Physical Therapist	022651	NY
3	2251S0007X	Sports Physical Therapist	022651	NY
4	2251X0800X	Orthopedic Physical Therapist	022651	NY

General Provider Information

NPI Number	:	1609083211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEHRBANOO MEHRROSTAMI P.T.

Provider Business Mailing Address
First Line	:	451 MINE BROOK RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2007
Country	:	US
Telephone Number	:	201-793-8988
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 MINE BROOK RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2007
Country	:	US
Telephone Number	:	201-793-8988
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	05/11/2016

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