1730511478 NPI number — PRO-CARE MEDICAL REHABILITATION P.C.

Table of content: (NPI 1730511478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730511478 NPI number — PRO-CARE MEDICAL REHABILITATION P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO-CARE MEDICAL REHABILITATION P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730511478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 WEBER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYREVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08872-1071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-254-8865
Provider Business Mailing Address Fax Number:
732-254-8865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13704 GUY BREWER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-848-3275
Provider Business Practice Location Address Fax Number:
718-848-3275
Provider Enumeration Date:
08/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MAKO
Authorized Official First Name:
SUNDAY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-848-3275

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  013592-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com