Healthcare Provider Details

I. General information

NPI: 1619165180
Provider Name (Legal Business Name): PHYSICAL MEDICINE & REHABILITATION CONSULTANT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 QUEENS BLVD
FOREST HILLS NY
11375-4365
US

IV. Provider business mailing address

10615 QUEENS BLVD
FOREST HILLS NY
11375-4365
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-6366
  • Fax: 718-263-3427
Mailing address:
  • Phone: 718-261-6366
  • Fax: 718-263-3427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number175535
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number126197
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number141612
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY LEWIS COLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-261-6366