MEDICARE: DR. ERSON PAUL RELIGIOSO III DPT

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	018386	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	837712	OTHER	NY	MANAGED PHYSICAL NETWORK
3	9310992	OTHER	NY	IHA
4	00011174501	OTHER	NY	UNIVERA
5	000626077001	OTHER	NY	BC/BS
6	6699290	OTHER	NY	GHI

General Provider Information

NPI Number	:	1881628709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERSON PAUL RELIGIOSO III DPT

Provider Business Mailing Address
First Line	:	6029 PINEHURST CT
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9203
Country	:	US
Telephone Number	:	716-980-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	6029 PINEHURST CT
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9203
Country	:	US
Telephone Number	:	716-980-5686
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/11/2017

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