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General NPI Number Information
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NPI Number | 1215448022
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Entity Type | Organization
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Legal Business Name | NY MOBILE REHAB LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 13829 QUEENS BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-2641
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Country | US
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Telephone | 917-470-4720
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Fax |
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Provider Business Mailing Address
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Address Line | 11044 65TH AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-1422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIYA GURG
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Credential |
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Telephone | 917-373-5913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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