Healthcare Provider Details

I. General information

NPI: 1649048620
Provider Name (Legal Business Name): KJD REHAB GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FORDHAM DR
PLAINVIEW NY
11803-1207
US

IV. Provider business mailing address

15 FORDHAM DR
PLAINVIEW NY
11803-1207
US

V. Phone/Fax

Practice location:
  • Phone: 917-756-2930
  • Fax:
Mailing address:
  • Phone: 917-756-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. KAREN DILEO
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 917-756-2930