=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760886188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JMP REHAB CARE, P.T. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2014
-----------------------------------------------------
Last Update Date | 10/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9254 QUEENS BLVD
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-1040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-426-5100
-----------------------------------------------------
Fax | 718-426-5110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2530 14TH ST FL 2
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11102-3721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-577-4074
-----------------------------------------------------
Fax | 718-426-5110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHN MICHAEL PECACHE
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 646-577-4074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 027839
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------