MEDICARE: VINCE RIAN T. PADIOS 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	047745-01	NY
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1770255655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCE RIAN T. PADIOS PT

Provider Business Mailing Address
First Line	:	1255 5TH AVE APT 6L
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-3996
Country	:	US
Telephone Number	:	914-400-1500
Fax Number	:	914-478-8781

Provider Business Practice Location Address
First Line	:	1 HANSON PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11243-2900
Country	:	US
Telephone Number	:	718-857-1900
Fax Number	:	718-857-1900

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

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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