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General NPI Number Information
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NPI Number | 1720318546
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Entity Type | Organization
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Legal Business Name | NEW YORK REHAB SPECIALIST, PC
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 4621 FORT HAMILTON PKWY
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City | BROOKLYN
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State | NY
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Zip | 11219-2414
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Country | US
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Telephone | 347-777-9707
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Fax |
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Provider Business Mailing Address
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Address Line | 6815 SELFRIDGE ST 2H
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City | FOREST HILLS
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State | NY
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Zip | 11375-5747
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Country | US
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Telephone | 347-777-9707
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARIEVIC EBORA VILLANUEVA
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Credential | PT
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Telephone | 347-777-9707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 030067
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License Number State | NY
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