MEDICARE: REHABILITATION

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	320700000X	Physical Disabilities Residential Treatment Facility	003295-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003295-1	OTHER	NY	LICENSURE

General Provider Information

NPI Number	:	1508929274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHABILITATION

Provider Business Mailing Address
First Line	:	210 E 102ND ST
Second Line	:	#13H
City	:	NEW YORK
State	:	NY
Zip	:	10029-5937
Country	:	US
Telephone Number	:	212-876-0659
Fax Number	:	212-876-0659

Provider Business Practice Location Address
First Line	:	210 E 102ND ST
Second Line	:	#13H
City	:	NEW YORK
State	:	NY
Zip	:	10029-5937
Country	:	US
Telephone Number	:	212-876-0659
Fax Number	:	212-876-0659

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST ASSISTANT
Name	:	MS. MARINA MATTEI I
Credential	:	O.T.A.
Telephone Number	:	917-470-7040

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	08/22/2020

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Directions to “REHABILITATION ” Practice Location

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