MEDICARE: QUEENS PHYSICAL MEDICINE & REHAB, 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	225400000X	Rehabilitation Practitioner	200303	NY

General Provider Information

NPI Number	:	1649507526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEENS PHYSICAL MEDICINE & REHAB, PC

Provider Business Mailing Address
First Line	:	8635 QUEENS BLVD
Second Line	:	1B
City	:	ELMHURST
State	:	NY
Zip	:	11373-4434
Country	:	US
Telephone Number	:	718-533-8588
Fax Number	:	718-533-1249

Provider Business Practice Location Address
First Line	:	8635 QUEENS BLVD
Second Line	:	1B
City	:	ELMHURST
State	:	NY
Zip	:	11373-4434
Country	:	US
Telephone Number	:	718-533-8588
Fax Number	:	718-533-1249

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JOSEPHINE BRAWNER
Credential	:	M.D.
Telephone Number	:	718-533-8588

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	11/12/2009

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