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NPI Code Detail

MEDICARE: CITIMED 360 PC

MEDICARE: CITIMED 360 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
1111N00000XChiropractor
2207X00000XOrthopaedic Surgery Physician
3208100000XPhysical Medicine & Rehabilitation Physician
42085R0202XDiagnostic Radiology Physician
5213E00000XPodiatrist
6225100000XPhysical Therapist
7207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1386476281
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITIMED 360 PC
Provider Business Mailing Address
First Line : 9901 63RD RD
Second Line :
City : REGO PARK
State : NY
Zip : 11374-1939
Country : US
Telephone Number : 718-509-9424
Fax Number :
Provider Business Practice Location Address
First Line : 1963 GRAND CONCOURSE FL 2
Second Line :
City : BRONX
State : NY
Zip : 10453-4995
Country : US
Telephone Number : 718-466-4600
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : TATYANA RABINOVICH
Credential :
Telephone Number : 718-509-9424
Provider Enumeration Date : 08/19/2024
Last Update Date : 08/19/2024

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