Healthcare Provider Details

I. General information

NPI: 1740291723
Provider Name (Legal Business Name): REHABILITATION MEDICINE CONSULTANTS OF NY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 SAINT RAYMONDS AVE 5TH FLOOR
BRONX NY
10461-3124
US

IV. Provider business mailing address

18436 HOVENDON RD
JAMAICA NY
11432-2424
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-5402
  • Fax: 718-430-7385
Mailing address:
  • Phone: 718-239-5402
  • Fax: 718-430-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number216861
License Number StateNY

VIII. Authorized Official

Name: DR. MARIA ANGELINA JOUVIN CASTRO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 718-239-5402