MEDICARE: JAIME GAMATERO PT 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
1	252Y00000X	Early Intervention Provider Agency	027029	NY

General Provider Information

NPI Number	:	1992175236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAIME GAMATERO PT P.C.

Provider Business Mailing Address
First Line	:	238 E NEW YORK AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6017
Country	:	US
Telephone Number	:	646-642-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 E NEW YORK AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6017
Country	:	US
Telephone Number	:	646-642-6598
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. JAIME M GAMATERO JR.
Credential	:	P.T.
Telephone Number	:	646-642-6598

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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