MEDICARE: EDMAR GOLOYUGO OT

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	225X00000X	Occupational Therapist	014863	NY

General Provider Information

NPI Number	:	1881914760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMAR GOLOYUGO OT

Provider Business Mailing Address
First Line	:	1602 EDISON AVE APT 3
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4800
Country	:	US
Telephone Number	:	212-281-8678
Fax Number	:	212-281-8677

Provider Business Practice Location Address
First Line	:	131 W 135TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2922
Country	:	US
Telephone Number	:	212-281-8678
Fax Number	:	212-281-8677

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

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/02/2010

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Directions to “ EDMAR GOLOYUGO OT” Practice Location

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