MEDICARE: TRI BORO DRIVER REHABILITATION & MOBILITY SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WV0202X	Vehicle Modifications Contractor

General Provider Information

NPI Number	:	1205550860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI BORO DRIVER REHABILITATION & MOBILITY SERVICES INC.

Provider Business Mailing Address
First Line	:	1642 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5808
Country	:	US
Telephone Number	:	718-414-2457
Fax Number	:

Provider Business Practice Location Address
First Line	:	1642 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5808
Country	:	US
Telephone Number	:	718-414-2457
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAANAN ZIDILE
Credential	:
Telephone Number	:	718-916-2891

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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