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NPI Code Detail

MEDICARE: PROVIDENCE REST OUTPATIENT REHABILITATION

MEDICARE: PROVIDENCE REST OUTPATIENT REHABILITATION
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
1314000000XSkilled Nursing Facility7000306NNY

General Provider Information

NPI Number : 1871754861
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE REST OUTPATIENT REHABILITATION
Provider Business Mailing Address
First Line : 3304 WATERBURY AVE
Second Line :
City : BRONX
State : NY
Zip : 10465-1554
Country : US
Telephone Number : 718-931-3000
Fax Number :
Provider Business Practice Location Address
First Line : 3304 WATERBURY AVE
Second Line :
City : BRONX
State : NY
Zip : 10465-1554
Country : US
Telephone Number : 718-931-3000
Fax Number :
Authorized Official
Title or Position : ACCOUNTS RECEIVABLE SUPERVISOR
Name : MRS. MARIA SPINA
Credential :
Telephone Number : 718-931-3000
Provider Enumeration Date : 06/23/2008
Last Update Date : 06/23/2008

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Directions to “PROVIDENCE REST OUTPATIENT REHABILITATION ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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