Healthcare Provider Details

I. General information

NPI: 1831475805
Provider Name (Legal Business Name): MILLENNIUM P.T. AND REHAB. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2011
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 COLDEN ST APT. 209
FLUSHING NY
11355-4845
US

IV. Provider business mailing address

4210 COLDEN ST SUITE. 209
FLUSHING NY
11355-4845
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-8910
  • Fax: 718-321-9022
Mailing address:
  • Phone: 718-321-8910
  • Fax: 718-321-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number016579-1
License Number StateNY

VIII. Authorized Official

Name: ANDRE DE MONTAGNAC
Title or Position: PRESIDENT
Credential: P.T.
Phone: 718-321-8910