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NPI Code Detail

MEDICARE: GILBERT LAVARIAS CHAN PT

MEDICARE: GILBERT LAVARIAS CHAN 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
12251X0800XOrthopedic Physical Therapist028152NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A400105691OTHERNYNGS MEDICARE

General Provider Information

NPI Number : 1871519819
Entity Type Code : Individual
Provider Name (Legal Business Name) : GILBERT LAVARIAS CHAN PT
Provider Business Mailing Address
First Line : 120 NEWHAM AVE
Second Line :
City : BRENTWOOD
State : NY
Zip : 11717-5624
Country : US
Telephone Number : 631-813-2143
Fax Number : 888-552-6176
Provider Business Practice Location Address
First Line : 145 DREISER LOOP
Second Line :
City : BRONX
State : NY
Zip : 10475-2704
Country : US
Telephone Number : 718-671-2955
Fax Number : 888-583-1385
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 03/22/2018

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Directions to “ GILBERT LAVARIAS CHAN PT” Practice Location

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