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General NPI Number Information
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NPI Number | 1760673479
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Entity Type | Organization
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Legal Business Name | YELLOWSTONE MEDICAL REHABILITATION, P.C.
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 6555 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-5048
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Country | US
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Telephone | 718-997-9696
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Fax | 718-997-0122
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Provider Business Mailing Address
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Address Line | 6555 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-5048
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Country | US
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Telephone | 718-997-9696
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Fax | 718-997-0122
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN MCGEE
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Credential | M.D.
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Telephone | 718-997-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X011196
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 165086
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License Number State | NY
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