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General NPI Number Information
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NPI Number | 1588949747
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Entity Type | Organization
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Legal Business Name | LEGEND REHABILITATION-ACUPUNCTURE & PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 1481 RICHMOND RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2309
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Country | US
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Telephone | 718-980-9888
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Fax | 718-980-1403
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Provider Business Mailing Address
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Address Line | 1481 RICHMOND RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2309
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Country | US
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Telephone | 718-980-9888
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Fax | 718-980-1403
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LAP C KU
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Credential | PT L.AC
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Telephone | 718-980-9888
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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 | 001272-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 14071
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License Number State | NY
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