MEDICARE: KYLE ROBERT ANSBACH

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	048082	NY

General Provider Information

NPI Number	:	1750002895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ROBERT ANSBACH

Provider Business Mailing Address
First Line	:	256 N WELLWOOD AVE
Second Line	:
City	:	LINDENHURST
State	:	NY
Zip	:	11757-3707
Country	:	US
Telephone Number	:	631-957-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 N WELLWOOD AVE
Second Line	:
City	:	LINDENHURST
State	:	NY
Zip	:	11757-3707
Country	:	US
Telephone Number	:	631-957-7300
Fax Number	:

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

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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