Healthcare Provider Details

I. General information

NPI: 1669924981
Provider Name (Legal Business Name): SKYLINE PHYSICAL MEDICINE & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BROAD ST SUITE 601
NEW YORK NY
10004-2315
US

IV. Provider business mailing address

40 BROAD ST SUITE 601
NEW YORK NY
10004-2315
US

V. Phone/Fax

Practice location:
  • Phone: 212-797-1200
  • Fax: 516-248-2380
Mailing address:
  • Phone: 212-797-1200
  • Fax: 516-248-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number278621-1
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL R MONFETT
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 516-294-4590