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General NPI Number Information
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NPI Number | 1508146341
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND PAIN & REHABILITATION, P.C.
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 4247 RICHMOND AVE LOWER LEVEL
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6220
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Country | US
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Telephone | 718-966-7246
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Fax | 718-966-7247
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Provider Business Mailing Address
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Address Line | 4247 RICHMOND AVE LOWER LEVEL
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6220
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Country | US
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Telephone | 718-966-7246
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Fax | 718-966-7247
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN LEUNG
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Credential | D.O.
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Telephone | 516-967-6255
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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 | A-243211-1
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License Number State | NY
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