MEDICARE: MR. WAI KEUNG KWOK 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	017005	NY

General Provider Information

NPI Number	:	1639456635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAI KEUNG KWOK P.T

Provider Business Mailing Address
First Line	:	6501 BAY PARKWAY
Second Line	:	C LEVEL
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3948
Country	:	US
Telephone Number	:	718-238-9392
Fax Number	:	718-238-9379

Provider Business Practice Location Address
First Line	:	6501 BAY PARKWAY, C LEVEL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3948
Country	:	US
Telephone Number	:	718-238-9392
Fax Number	:	718-238-9379

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

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	11/04/2011

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