MEDICARE: MR. JOSEPH PAUL MORELLO I

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	225200000X	Physical Therapy Assistant	012434	NY

General Provider Information

NPI Number	:	1982367983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH PAUL MORELLO I

Provider Business Mailing Address
First Line	:	9102 COLONIAL RD APT 4D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-6156
Country	:	US
Telephone Number	:	347-515-1840
Fax Number	:

Provider Business Practice Location Address
First Line	:	9102 COLONIAL RD APT 4D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-6156
Country	:	US
Telephone Number	:	347-515-1840
Fax Number	:

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

Provider Enumeration Date	:	10/16/2021
Last Update Date	:	10/16/2021

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