Organization
PRO CARE PHYSICAL THERAPY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICIO MARK CLEMENTE ZAMORA RPT (PHYSICAL THERAPIST)
(917) 774-1436
Entity
Organization
Contact information
Practice address
4111 30TH AVE STE C, ASTORIA, NY 11103-2913
(718) 274-4400
Mailing address
4111 30TH AVE STE C, ASTORIA, NY 11103-2913
(718) 274-4400
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
025676
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04255Q
MEDICARE/GHI
NY
Enumeration date
03/02/2009
Last updated
03/02/2009
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