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General NPI Number Information
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NPI Number | 1538400858
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Entity Type | Organization
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Legal Business Name | PRO-HEALTH MEDICAL REHAB
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 7309 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-2603
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Country | US
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Telephone | 347-668-9667
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Fax | 718-746-4920
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Provider Business Mailing Address
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Address Line | 7309 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-2603
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Country | US
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Telephone | 347-668-9667
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Fax | 718-746-4920
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MUN
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Credential | MD
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Telephone | 347-668-9667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 234121
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 234121
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License Number State | NY
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