Healthcare Provider Details

I. General information

NPI: 1538646856
Provider Name (Legal Business Name): JGB REHABILITATION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 64 ST
NEW YORK NY
10023-6301
US

IV. Provider business mailing address

80 W END AVE
NEW YORK NY
10023-6301
US

V. Phone/Fax

Practice location:
  • Phone: 212-769-6247
  • Fax:
Mailing address:
  • Phone: 212-769-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7002131R
License Number StateNY

VIII. Authorized Official

Name: MAURA J SWEENEY
Title or Position: SVP
Credential:
Phone: 212-769-6247