MEDICARE: YERU REHAB PT PC

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	261Q00000X	Clinic/Center	023756-1	NY

General Provider Information

NPI Number	:	1255390332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YERU REHAB PT PC

Provider Business Mailing Address
First Line	:	1250 40TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1937
Country	:	US
Telephone Number	:	718-288-3109
Fax Number	:	718-633-7061

Provider Business Practice Location Address
First Line	:	1250 40TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1937
Country	:	US
Telephone Number	:	718-288-3109
Fax Number	:	718-633-7061

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. SOLOMON MAYER
Credential	:	PT
Telephone Number	:	718-288-3109

Provider Enumeration Date	:	03/19/2006
Last Update Date	:	11/21/2017

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