MEDICARE: HECTOR LUIS LOZADA PT

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	024465-1	NY

General Provider Information

NPI Number	:	1912070236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR LUIS LOZADA PT

Provider Business Mailing Address
First Line	:	2161 HAZEN ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1019
Country	:	US
Telephone Number	:	347-259-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 39TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11232-2550
Country	:	US
Telephone Number	:	646-422-5900
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	04/11/2021

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