MEDICARE: WALL STREET PHYSICAL MEDICINE & REHABILITATION, P.C.

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

General Provider Information

NPI Number	:	1952425381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALL STREET PHYSICAL MEDICINE & REHABILITATION, P.C.

Provider Business Mailing Address
First Line	:	61 BROADWAY
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10006-2701
Country	:	US
Telephone Number	:	212-248-0077
Fax Number	:	212-747-0939

Provider Business Practice Location Address
First Line	:	61 BROADWAY
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10006-2701
Country	:	US
Telephone Number	:	212-248-0077
Fax Number	:	212-747-0939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD KOFFLER
Credential	:	M.D.
Telephone Number	:	212-248-0077

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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