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General NPI Number Information
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NPI Number | 1407893662
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Entity Type | Organization
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Legal Business Name | MEDICINE AND REHABILITATION PC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 333 SYLVAN AVE STE 111
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2705
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Country | US
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Telephone | 201-568-8500
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Fax | 201-568-8518
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417-0037
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Country | US
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Telephone | 201-568-8500
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Fax | 201-568-8518
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREI LOGVINENKO
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Credential | M.D.
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Telephone | 201-568-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MA63969
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA67595
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License Number State | NJ
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