Healthcare Provider Details

I. General information

NPI: 1215958764
Provider Name (Legal Business Name): OUTPATIENT REHAB. CENTERS OF N.Y.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DREISER LOOP
BRONX NY
10475
US

IV. Provider business mailing address

PO BOX 2126
EDEN NC
27289-2126
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2955
  • Fax: 888-583-1285
Mailing address:
  • Phone: 336-627-6543
  • Fax: 336-627-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DENISE FERGUSON
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 336-627-6543