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NPI Code Detail

MEDICARE: I-OM PHYSICAL THERAPY P.C

MEDICARE: I-OM PHYSICAL THERAPY P.C
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
12251X0800XOrthopedic Physical Therapist023922-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q12X23OTHERNYMEDICARE ID

General Provider Information

NPI Number : 1912237264
Entity Type Code : Organization
Provider Name (Legal Business Name) : I-OM PHYSICAL THERAPY P.C
Provider Business Mailing Address
First Line : 15 PARK ROW
Second Line : 15J
City : NEW YORK
State : NY
Zip : 10038-2301
Country : US
Telephone Number : 917-658-0955
Fax Number :
Provider Business Practice Location Address
First Line : 111 JOHN ST
Second Line : SUITE 1445
City : NEW YORK
State : NY
Zip : 10038-3101
Country : US
Telephone Number : 917-715-1540
Fax Number :
Authorized Official
Title or Position : PHYSICAL THERAPIST
Name : MARY BUENCONSEJO
Credential :
Telephone Number : 212-571-4800
Provider Enumeration Date : 01/09/2010
Last Update Date : 08/06/2012

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Directions to “I-OM PHYSICAL THERAPY P.C ” Practice Location

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