MEDICARE: NEW YORK PHYSICAL AND OCCUPATIONAL THERAPH PLLC

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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1952321366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK PHYSICAL AND OCCUPATIONAL THERAPH PLLC

Provider Business Mailing Address
First Line	:	569 E MAIN STREET
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8505
Country	:	US
Telephone Number	:	631-665-8645
Fax Number	:	631-665-8646

Provider Business Practice Location Address
First Line	:	2412 GERRITSEN AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	718-769-9386
Fax Number	:	888-583-1272

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MS. IRENE DEL PERCIO
Credential	:
Telephone Number	:	631-665-8645

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/15/2008

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