MEDICARE: MICHAEL URBANOWICZ PHYSICAL THERAPIST

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	QA02948	NJ

General Provider Information

NPI Number	:	1881645687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL URBANOWICZ PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	194 MAIN ST
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1144
Country	:	US
Telephone Number	:	973-564-9559
Fax Number	:	973-564-9717

Provider Business Practice Location Address
First Line	:	52 VANDERBILT AVE
Second Line	:	SUITE 1413
City	:	NEW YORK
State	:	NY
Zip	:	10017-3808
Country	:	US
Telephone Number	:	212-599-0099
Fax Number	:	212-599-0389

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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