Healthcare Provider Details

I. General information

NPI: 1477570315
Provider Name (Legal Business Name): EAST COAST REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 JEROME AVE
BRONX NY
10452-3301
US

IV. Provider business mailing address

1221 JEROME AVE
BRONX NY
10452-3301
US

V. Phone/Fax

Practice location:
  • Phone: 718-538-8343
  • Fax: 718-538-8356
Mailing address:
  • Phone: 718-538-8343
  • Fax: 718-538-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number220243
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number220248
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number220248
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNY

VIII. Authorized Official

Name: LEO FUTERMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-538-8343