Provider Demographics
NPI:1952403354
Name:TAROS, JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:TAROS
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 1:142 JORALEMON ST
Mailing Address - Street 2:SUITE 11A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-875-3167
Mailing Address - Fax:718-834-0242
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 11A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-875-3167
Practice Address - Fax:718-834-0242
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0021451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4502004OtherAETNA
19881POtherHIP
KS150OtherOXFORD
NY00362336Medicaid
NY00362336Medicaid