Healthcare Provider Details

I. General information

NPI: 1740456268
Provider Name (Legal Business Name): 7TH AVENUE PHYSICAL MEDICINE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 7TH AVE FL 14
NEW YORK NY
10018-4603
US

IV. Provider business mailing address

512 7TH AVE FL 14
NEW YORK NY
10018-4603
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-7979
  • Fax: 212-768-1223
Mailing address:
  • Phone: 212-768-7979
  • Fax: 212-768-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT REALE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 212-768-7979