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General NPI Number Information
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NPI Number | 1376935676
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Entity Type | Organization
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Legal Business Name | RECOVERY PT REHAB, PC
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 15054 COOLIDGE AVE
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City | JAMAICA
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State | NY
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Zip | 11432-1622
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Country | US
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Telephone | 718-880-2886
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Fax |
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Provider Business Mailing Address
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Address Line | 15054 COOLIDGE AVE
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City | JAMAICA
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State | NY
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Zip | 11432-1622
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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 | PRESIDENT
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Name | ASNODIN DIANALAN
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Credential |
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Telephone | 646-441-0362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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