MEDICARE: PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF STATEN ISLAND LLP

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	174400000X	Specialist	182903	NY

General Provider Information

NPI Number	:	1285842815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF STATEN ISLAND LLP

Provider Business Mailing Address
First Line	:	361 EDISON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3043
Country	:	US
Telephone Number	:	718-980-0101
Fax Number	:	718-980-1641

Provider Business Practice Location Address
First Line	:	361 EDISON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3043
Country	:	US
Telephone Number	:	718-980-0101
Fax Number	:	718-980-1641

Authorized Official
Title or Position	:	PARTNER-OWNER
Name	:	DR. PERRY DEAN DRUCKER
Credential	:	M.D.
Telephone Number	:	718-908-0101

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	12/16/2008

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