Healthcare Provider Details

I. General information

NPI: 1043884687
Provider Name (Legal Business Name): MILLENNIUM REHABILITATION PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 11/06/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 W 235TH ST
BRONX NY
10463-1795
US

IV. Provider business mailing address

531 W 235TH ST
BRONX NY
10463-1795
US

V. Phone/Fax

Practice location:
  • Phone: 718-432-1323
  • Fax:
Mailing address:
  • Phone: 212-927-8039
  • Fax: 646-559-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXANDER SHERMAN
Title or Position: OWNER
Credential: P.T.
Phone: 718-432-1323