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General NPI Number Information
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NPI Number | 1679195499
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Entity Type | Organization
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Legal Business Name | VITAL REHAB LLC
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 3165 NOSTRAND AVE APT 4E
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City | BROOKLYN
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State | NY
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Zip | 11229-3243
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Country | US
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Telephone | 646-872-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 3165 NOSTRAND AVE APT 4E
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City | BROOKLYN
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State | NY
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Zip | 11229-3243
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Country | US
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Telephone | 646-872-8288
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | EUGENE ISRAILOV
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Credential | PT, DPT
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Telephone | 646-872-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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