Healthcare Provider Details

I. General information

NPI: 1831600741
Provider Name (Legal Business Name): NY MOBILE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 110TH ST
FOREST HILLS NY
11375-1436
US

IV. Provider business mailing address

6442 110TH ST
FOREST HILLS NY
11375-1436
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-4720
  • Fax:
Mailing address:
  • Phone: 917-470-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIYA GURG
Title or Position: CEO
Credential:
Phone: 917-470-4720