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General NPI Number Information
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NPI Number | 1588940464
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Entity Type | Organization
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Legal Business Name | QUEENS REHABILITATION & DIAGNOSTICS
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 21435 42ND AVE 3RD FLOOR
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-229-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 21435 42ND AVE 3RD FLOOR
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-229-4868
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STANLEY J MATHEW
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Credential | M.D.
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Telephone | 718-229-4868
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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 |
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License Number State |
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