MEDICARE: BD MANUAL REHAB PT 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1750839981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BD MANUAL REHAB PT PC

Provider Business Mailing Address
First Line	:	301 OCEAN VIEW AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6826
Country	:	US
Telephone Number	:	929-371-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 OCEAN VIEW AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6826
Country	:	US
Telephone Number	:	929-371-2131
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. BORIS DOLUB
Credential	:	DPT
Telephone Number	:	929-371-2131

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/16/2016

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