Healthcare Provider Details

I. General information

NPI: 1588940464
Provider Name (Legal Business Name): QUEENS REHABILITATION & DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21435 42ND AVE 3RD FLOOR
BAYSIDE NY
11361
US

IV. Provider business mailing address

21435 42ND AVE 3RD FLOOR
BAYSIDE NY
11361
US

V. Phone/Fax

Practice location:
  • Phone: 718-229-4868
  • Fax:
Mailing address:
  • Phone: 718-229-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY J MATHEW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-229-4868