MEDICARE: NY MOBILE REHAB LLC

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1215448022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY MOBILE REHAB LLC

Provider Business Mailing Address
First Line	:	11044 65TH AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13829 QUEENS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-2641
Country	:	US
Telephone Number	:	917-470-4720
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIYA GURG
Credential	:
Telephone Number	:	917-373-5913

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	06/16/2018

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