MEDICARE: BENSONHURST PHYSICAL THERAPY PC

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	022729	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932455748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENSONHURST PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	1706 CROPSEY AVE
Second Line	:	SUITE C, D
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5861
Country	:	US
Telephone Number	:	718-259-1010
Fax Number	:	718-259-3705

Provider Business Practice Location Address
First Line	:	1706 CROPSEY AVE
Second Line	:	SUITE C, D
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5861
Country	:	US
Telephone Number	:	718-259-1010
Fax Number	:	718-259-3705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERNESTO NOBLEZA VILLAS JR.
Credential	:	PT
Telephone Number	:	347-204-6099

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	07/30/2012

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Directions to “BENSONHURST PHYSICAL THERAPY PC ” Practice Location

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