MEDICARE: CARIE K SUMIDA D.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	2251P0200X	Pediatric Physical Therapist	021901-1	NY

General Provider Information

NPI Number	:	1659495075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIE K SUMIDA D.P.T.

Provider Business Mailing Address
First Line	:	357 E 68TH ST
Second Line	:	1A
City	:	NEW YORK
State	:	NY
Zip	:	10021-5660
Country	:	US
Telephone Number	:	917-881-2690
Fax Number	:

Provider Business Practice Location Address
First Line	:	357 E 68TH ST
Second Line	:	1A
City	:	NEW YORK
State	:	NY
Zip	:	10021-5660
Country	:	US
Telephone Number	:	917-881-2690
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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