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NPI Code Detail

MEDICARE: MS. ELAINE S MOGOLLON PT

MEDICARE: MS. ELAINE S MOGOLLON 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
12251P0200XPediatric Physical Therapist016726-1NY

General Provider Information

NPI Number : 1699918276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELAINE S MOGOLLON PT
Provider Business Mailing Address
First Line : 6 OHIO DR
Second Line : SUITE 202
City : NEW HYDE PARK
State : NY
Zip : 11042-1129
Country : US
Telephone Number : 718-281-8949
Fax Number : 516-302-8657
Provider Business Practice Location Address
First Line : 6 OHIO DR
Second Line : SUITE 202
City : NEW HYDE PARK
State : NY
Zip : 11042-1129
Country : US
Telephone Number : 718-281-8949
Fax Number : 516-302-8657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2009
Last Update Date : 04/13/2009

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Directions to “ MS. ELAINE S MOGOLLON PT” Practice Location

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