MEDICARE: MR. ARNOLD TRACHTENBERG PTA

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	225200000X	Physical Therapy Assistant	002817-1	NY

General Provider Information

NPI Number	:	1689612558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARNOLD TRACHTENBERG PTA

Provider Business Mailing Address
First Line	:	450 CLARKSON AVE
Second Line	:	BOX 1262
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2056
Country	:	US
Telephone Number	:	718-270-8867
Fax Number	:	718-270-1794

Provider Business Practice Location Address
First Line	:	710 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1508
Country	:	US
Telephone Number	:	718-270-2045
Fax Number	:	718-270-3763

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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