MEDICARE: NJS PHYSICAL MEDICINE AND 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	208100000X	Physical Medicine & Rehabilitation Physician	187572	NY

General Provider Information

NPI Number	:	1801294400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NJS PHYSICAL MEDICINE AND REHABILITATION, PC

Provider Business Mailing Address
First Line	:	1178 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7005
Country	:	US
Telephone Number	:	516-294-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1178 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7005
Country	:	US
Telephone Number	:	516-294-4590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NUNZIO SAULLE
Credential	:	MD
Telephone Number	:	516-294-4590

Provider Enumeration Date	:	12/12/2014
Last Update Date	:	06/23/2016

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