MEDICARE: REHAB ONE 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	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q0W4R1	OTHER	NY	MEDICARE ID

General Provider Information

NPI Number	:	1962673665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB ONE PC

Provider Business Mailing Address
First Line	:	1236 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2093
Country	:	US
Telephone Number	:	718-398-9600
Fax Number	:	718-398-9700

Provider Business Practice Location Address
First Line	:	1236 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2093
Country	:	US
Telephone Number	:	718-398-9600
Fax Number	:	718-398-9700

Authorized Official
Title or Position	:	PT
Name	:	IGOR OLEVSKY
Credential	:	PT
Telephone Number	:	718-398-9600

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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Directions to “REHAB ONE PC ” Practice Location

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