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General NPI Number Information
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NPI Number | 1457670101
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Entity Type | Organization
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Legal Business Name | COMPLETE REHAB MEDICINE CARE P.C.
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 130 WADSWORTH AVE APT 4
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City | NEW YORK
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State | NY
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Zip | 10033-4823
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Country | US
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Telephone | 212-928-5959
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Fax | 212-928-5189
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Provider Business Mailing Address
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Address Line | 250 S END AVE APT 6C
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City | NEW YORK
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State | NY
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Zip | 10280-1076
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Country | US
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Telephone | 718-205-4911
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Fax | 718-205-5946
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Authorized Official
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Title or Position | MANAGER
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Name | YOKAIRA DUVERGE
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Credential |
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Telephone | 718-205-4911
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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 | 190946
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License Number State | NY
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