MEDICARE: JILU JOHN 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	053327	NY

General Provider Information

NPI Number	:	1619860319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILU JOHN PT

Provider Business Mailing Address
First Line	:	928 N 1ST ST # NA
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2822
Country	:	US
Telephone Number	:	678-467-2578
Fax Number	:	516-555-1234

Provider Business Practice Location Address
First Line	:	246 JERICHO TPKE # NA
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-2147
Country	:	US
Telephone Number	:	516-531-7879
Fax Number	:	516-773-7315

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

Provider Enumeration Date	:	05/31/2025
Last Update Date	:	05/31/2025

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Directions to “ JILU JOHN PT” Practice Location

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