MEDICARE: MATILDA ABIOLA REHAB CARE LLC

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	252Y00000X	Early Intervention Provider Agency	015651	NY

General Provider Information

NPI Number	:	1760938088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATILDA ABIOLA REHAB CARE LLC

Provider Business Mailing Address
First Line	:	1592 E 91ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5218
Country	:	US
Telephone Number	:	917-412-0190
Fax Number	:	866-230-0943

Provider Business Practice Location Address
First Line	:	1592 E91ST STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5218
Country	:	US
Telephone Number	:	917-412-0190
Fax Number	:	866-230-0943

Authorized Official
Title or Position	:	REGISTERED PHYSICAL THERAPIST
Name	:	MRS. MATILDA ABIMBOLA ABIOLA
Credential	:
Telephone Number	:	917-412-0190

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	08/28/2016

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