Provider Demographics
NPI:1538115381
Name:MAURO, TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MAURO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4709
Mailing Address - Country:US
Mailing Address - Phone:516-794-3278
Mailing Address - Fax:516-794-7578
Practice Address - Street 1:645 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4709
Practice Address - Country:US
Practice Address - Phone:516-794-3278
Practice Address - Fax:516-794-7578
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQA229Q4FH1OtherMEDICARE PTAN