Healthcare Provider Details

I. General information

NPI: 1700932944
Provider Name (Legal Business Name): GARDEN CITY PHYSICAL MEDICINE AND REHABILITATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292A HERRICKS RD
MINEOLA NY
11501-1119
US

IV. Provider business mailing address

292A HERRICKS RD
MINEOLA NY
11501-1119
US

V. Phone/Fax

Practice location:
  • Phone: 516-877-0011
  • Fax:
Mailing address:
  • Phone: 516-877-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number38203
License Number StateNY

VIII. Authorized Official

Name: DR. PHILIP BURNS
Title or Position: PRES
Credential: D.O.
Phone: 516-877-0011