Healthcare Provider Details

I. General information

NPI: 1912221680
Provider Name (Legal Business Name): PAPPAS PHYSICAL MEDICINE & REHABILITATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 31ST ST
ASTORIA NY
11106-2530
US

IV. Provider business mailing address

PO BOX 9305
GARDEN CITY NY
11530-9305
US

V. Phone/Fax

Practice location:
  • Phone: 718-274-0300
  • Fax:
Mailing address:
  • Phone: 516-294-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number2220591
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number2220591
License Number StateNY

VIII. Authorized Official

Name: MR. MIKE MENELAOS PAPPAS
Title or Position: OWNER
Credential: D.O.
Phone: 516-294-4590