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General NPI Number Information
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NPI Number | 1821371899
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Entity Type | Organization
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Legal Business Name | FOREST REHABILITATION MEDICINE PC
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 3077 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4113
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Country | US
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Telephone | 718-980-9020
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Fax | 718-980-9030
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Provider Business Mailing Address
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Address Line | 361 EDISON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3043
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Country | US
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Telephone | 718-980-0101
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Fax | 718-980-1641
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHRISTOPHER MICHAEL PEREZ
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Credential | MD
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Telephone | 718-876-0203
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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 | 225293
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License Number State | NY
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