MEDICARE: MR. HAROLD M MONIZ 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	225100000X	Physical Therapist	034240-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	034240	OTHER	NY	NYSED

General Provider Information

NPI Number	:	1689951972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAROLD M MONIZ PT

Provider Business Mailing Address
First Line	:	260 MIDDLE COUNTRY RD
Second Line	:	BUILDING 3, SUITE 9 -A
City	:	SELDEN
State	:	NY
Zip	:	11784-2568
Country	:	US
Telephone Number	:	201-744-4309
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 MIDDLE COUNTRY RD
Second Line	:	BUILDING 3, SUITE 9 -A
City	:	SELDEN
State	:	NY
Zip	:	11784-2568
Country	:	US
Telephone Number	:	201-744-4309
Fax Number	:

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	05/02/2013

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Directions to “ MR. HAROLD M MONIZ PT” Practice Location

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