1033123039 NPI number — JGB REHABILITATION CORPORATION

Table of content: JONATHAN GOLDBERG PT (NPI 1720197304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033123039 NPI number — JGB REHABILITATION CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JGB REHABILITATION CORPORATION
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:
1033123039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 WEST 64TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-769-6313
Provider Business Mailing Address Fax Number:
212-769-7825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 WEST 64TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-769-6313
Provider Business Practice Location Address Fax Number:
212-769-7825
Provider Enumeration Date:
07/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
MAURA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF PROGRAM AND SERVICES OFFICER
Authorized Official Telephone Number:
212-769-6247

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  7002131R , 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)

  • Identifier: 01061105 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".