MEDICARE: GARY P GUERRIERO P.T.

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	008080-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22-3580299	OTHER	NY	TAX ID

General Provider Information

NPI Number	:	1992763551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY P GUERRIERO P.T.

Provider Business Mailing Address
First Line	:	515 MADISON AVE
Second Line	:	FLOOR 3
City	:	NEW YORK
State	:	NY
Zip	:	10022-5403
Country	:	US
Telephone Number	:	212-355-8440
Fax Number	:	212-355-8439

Provider Business Practice Location Address
First Line	:	515 MADISON AVE
Second Line	:	FLOOR 3
City	:	NEW YORK
State	:	NY
Zip	:	10022-5403
Country	:	US
Telephone Number	:	212-355-8440
Fax Number	:	212-355-8439

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/22/2008

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