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General NPI Number Information
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NPI Number | 1508929274
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Entity Type | Organization
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Legal Business Name | REHABILITATION
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 210 E 102ND ST #13H
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City | NEW YORK
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State | NY
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Zip | 10029-5937
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Country | US
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Telephone | 212-876-0659
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Fax | 212-876-0659
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Provider Business Mailing Address
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Address Line | 210 E 102ND ST #13H
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City | NEW YORK
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State | NY
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Zip | 10029-5937
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Country | US
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Telephone | 212-876-0659
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Fax | 212-876-0659
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST ASSISTANT
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Name | MS. MARINA MATTEI I
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Credential | O.T.A.
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Telephone | 917-470-7040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 003295-1
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License Number State | NY
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