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General NPI Number Information
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NPI Number | 1952425381
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Entity Type | Organization
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Legal Business Name | WALL STREET PHYSICAL MEDICINE & REHABILITATION, P.C.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 61 BROADWAY SUITE 900
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City | NEW YORK
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State | NY
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Zip | 10006-2701
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Country | US
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Telephone | 212-248-0077
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Fax | 212-747-0939
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Provider Business Mailing Address
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Address Line | 61 BROADWAY SUITE 900
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City | NEW YORK
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State | NY
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Zip | 10006-2701
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Country | US
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Telephone | 212-248-0077
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Fax | 212-747-0939
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD KOFFLER
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Credential | M.D.
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Telephone | 212-248-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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