=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770663601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESAPEAKE REHABILITATION GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 SHIPPING PL # 61
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21222-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-285-7060
-----------------------------------------------------
Fax | 212-500-3338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2171 E 70TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-576-7467
-----------------------------------------------------
Fax | 212-212-5003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DIMITRY A. KARGMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-576-7467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------