MEDICARE: NAFTALI FOGEL 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	261QP2000X	Physical Therapy Clinic/Center	025391	NY
2	225100000X	Physical Therapist	025391	NY

General Provider Information

NPI Number	:	1679751044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAFTALI FOGEL PT

Provider Business Mailing Address
First Line	:	1222 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4822
Country	:	US
Telephone Number	:	347-881-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4822
Country	:	US
Telephone Number	:	347-881-6151
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	07/16/2020

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