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General NPI Number Information
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NPI Number | 1508040650
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Entity Type | Organization
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Legal Business Name | DR. MA'S MEDICAL REHAB., P.C.
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 13620 38 AVE 6M
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City | FLUSHING
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State | NY
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Zip | 11354
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Country | US
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Telephone | 718-888-1513
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Fax | 718-514-7031
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Provider Business Mailing Address
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Address Line | 41 ROBERT CIR
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City | SYOSSET
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State | NY
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Zip | 11791-3829
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Country | US
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Telephone | 516-558-7886
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KEYAN MA
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Credential | M.D.
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Telephone | 718-888-1513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 226971
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License Number State | NY
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