MEDICARE: MARIA ELENA MONICA JUSON P.T.

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	62 017893	NY

General Provider Information

NPI Number	:	1881839868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELENA MONICA JUSON P.T.

Provider Business Mailing Address
First Line	:	7210 164TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-4222
Country	:	US
Telephone Number	:	718-591-2064
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 164TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-4222
Country	:	US
Telephone Number	:	718-591-2064
Fax Number	:

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

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	09/30/2019

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