Healthcare Provider Details

I. General information

NPI: 1750572897
Provider Name (Legal Business Name): BRONX REHABILITATION MEDICINE & PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 MORRIS PARK AVE
BRONX NY
10462-3714
US

IV. Provider business mailing address

984 MORRIS PARK AVE
BRONX NY
10462-3714
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-7676
  • Fax: 718-823-7675
Mailing address:
  • Phone: 718-823-7676
  • Fax: 718-823-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number202599
License Number StateNY

VIII. Authorized Official

Name: DR. ALBERT VILLAFUERTE
Title or Position: PROPRIETOR
Credential: MD
Phone: 718-823-7676