Organization
I-OM PHYSICAL THERAPY P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BUENCONSEJO (PHYSICAL THERAPIST)
(212) 571-4800
Entity
Organization
Contact information
Practice address
111 JOHN ST, SUITE 1445, NEW YORK, NY 10038-3101
(917) 715-1540
Mailing address
15 PARK ROW, 15J, NEW YORK, NY 10038-2301
(917) 658-0955
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
023922-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q12X23
MEDICARE ID
NY
Enumeration date
01/09/2010
Last updated
08/06/2012
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