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General NPI Number Information
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NPI Number | 1619367844
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Entity Type | Organization
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Legal Business Name | REHABILITATION ASSOCIATE OF LI PHYSICAL MEDICINE PLLC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 3601 HEMPSTEAD TPKE STE 503
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City | LEVITTOWN
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State | NY
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Zip | 11756-1376
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Country | US
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Telephone | 516-864-0557
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Fax | 516-864-0559
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Provider Business Mailing Address
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Address Line | 3601 HEMPSTEAD TPKE STE 503
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City | LEVITTOWN
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State | NY
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Zip | 11756-1376
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Country | US
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Telephone | 516-864-0557
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Fax | 516-864-0559
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALTER JAMES GAUDINO
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Credential | M.D.
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Telephone | 516-864-0557
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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 | 185629-1
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License Number State | NY
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