MEDICARE: VICSON TONGOL LIMLINGAN BSPT

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	40QA00978800	NJ

General Provider Information

NPI Number	:	1851500367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICSON TONGOL LIMLINGAN BSPT

Provider Business Mailing Address
First Line	:	461 ELIZABETH ST
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-1014
Country	:	US
Telephone Number	:	201-726-2211
Fax Number	:	201-244-6974

Provider Business Practice Location Address
First Line	:	800 RIVER RD
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-3127
Country	:	US
Telephone Number	:	201-967-1700
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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