MEDICARE: KENAN TREBINCEVIC MSPT

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	028312	NY
2	225100000X	Physical Therapist	14.007695	CT

General Provider Information

NPI Number	:	1679598593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENAN TREBINCEVIC MSPT

Provider Business Mailing Address
First Line	:	800 POST RD
Second Line	:	SUITE 3A
City	:	DARIEN
State	:	CT
Zip	:	06820-4622
Country	:	US
Telephone Number	:	203-422-0679
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W 45TH ST STE 301
Second Line	:	301
City	:	NEW YORK
State	:	NY
Zip	:	10036-4005
Country	:	US
Telephone Number	:	212-300-5545
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/29/2016

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Directions to “ KENAN TREBINCEVIC MSPT” Practice Location

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