MEDICARE: BEACH MEDICAL REHABILITATION 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	261QM1300X	Multi-Specialty Clinic/Center	165086	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06680	OTHER	NY	GHI MEDICARE PIN

General Provider Information

NPI Number	:	1518172907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH MEDICAL REHABILITATION PC

Provider Business Mailing Address
First Line	:	18 GREENLAWN RD
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2926
Country	:	US
Telephone Number	:	516-426-8177
Fax Number	:	631-421-0786

Provider Business Practice Location Address
First Line	:	520 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3622
Country	:	US
Telephone Number	:	718-327-5011
Fax Number	:	718-327-1156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN J MCGEE
Credential	:	D.O.
Telephone Number	:	516-426-8177

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	01/15/2013

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