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General NPI Number Information
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NPI Number | 1750468831
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Entity Type | Organization
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Legal Business Name | PHYSICIANS MEDICAL REHABILITATION ASSOCIATES, PLLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 21316 39TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-2045
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Country | US
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Telephone | 718-229-7800
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Fax | 718-279-7470
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Provider Business Mailing Address
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Address Line | 213-16 39TH AVENUE
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-229-7800
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Fax | 718-279-7470
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN S VLATTAS
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Credential | M.D.
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Telephone | 718-229-7800
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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 |
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License Number State |
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