MEDICARE: MR. PEDRO LUIS ESTEVEZ OTRL

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	011762	NY

General Provider Information

NPI Number	:	1912052747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PEDRO LUIS ESTEVEZ OTRL

Provider Business Mailing Address
First Line	:	22122 106TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2431
Country	:	US
Telephone Number	:	212-939-4438
Fax Number	:	212-939-4405

Provider Business Practice Location Address
First Line	:	506 MALCOLM X BLVD
Second Line	:	3RD FL RM 3136
City	:	NEW YORK
State	:	NY
Zip	:	10037-1802
Country	:	US
Telephone Number	:	212-939-4438
Fax Number	:	212-939-4405

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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