MEDICARE: NIEVES JANE OSANO ESPINOSA

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	04286801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042868-01	OTHER	NY	PRIVATE INSURANCE

General Provider Information

NPI Number	:	1881330454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIEVES JANE OSANO ESPINOSA

Provider Business Mailing Address
First Line	:	1817 BARNES AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3607
Country	:	US
Telephone Number	:	650-878-7641
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 BARNES AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3607
Country	:	US
Telephone Number	:	650-878-7641
Fax Number	:

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

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	05/06/2022

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