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General NPI Number Information
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NPI Number | 1730307208
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Entity Type | Organization
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Legal Business Name | PORT REHAB MEDICAL P.C.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 535 BROADHOLLOW RD STE A10
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City | MELVILLE
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State | NY
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Zip | 11747-3701
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Country | US
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Telephone | 718-677-0937
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Fax |
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Provider Business Mailing Address
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Address Line | 3857 KINGS HWY STE. 1I
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City | BROOKLYN
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State | NY
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Zip | 11234-2943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NIRMAL KADE
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Credential | M.D.
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Telephone | 718-677-0937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 154738-2
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License Number State | NY
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