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General NPI Number Information
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NPI Number | 1699239715
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Entity Type | Organization
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Legal Business Name | MK SPINE AND JOINT REHAB, P.C.
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 500 OLD COUNTRY RD STE 300
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City | GARDEN CITY
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State | NY
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Zip | 11530-1944
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Country | US
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Telephone | 631-335-9935
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Fax |
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Provider Business Mailing Address
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Address Line | 500 OLD COUNTRY RD
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City | GARDEN CITY
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State | NY
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Zip | 11530-1901
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Country | US
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Telephone | 516-757-4466
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Fax | 631-940-1557
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW HOWARD KALTER
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Credential | MD
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Telephone | 631-335-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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