Healthcare Provider Details

I. General information

NPI: 1275727158
Provider Name (Legal Business Name): ADVANCED REHABILITATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 HYLON BLVD.
STATEN ISLAND NY
10306
US

IV. Provider business mailing address

2305 HYLAN BLVD.
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-0297
  • Fax: 718-667-1945
Mailing address:
  • Phone: 718-667-0297
  • Fax: 718-667-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015531
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01008700
License Number StateNJ

VIII. Authorized Official

Name: JULIA SAPOFF
Title or Position: OWNER
Credential: PT
Phone: 917-520-4337