1790196004 NPI number — BEL REHABILITATION PT, PC.

Table of content: (NPI 1790196004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790196004 NPI number — BEL REHABILITATION PT, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEL REHABILITATION PT, PC.
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:
1790196004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8829 180TH ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11432-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-596-8927
Provider Business Mailing Address Fax Number:
888-773-1644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 OCEAN AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11518-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-596-8927
Provider Business Practice Location Address Fax Number:
888-773-1644
Provider Enumeration Date:
05/08/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
BASILIO
Authorized Official Middle Name:
ESPINO
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
914-426-7423

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  027734 , 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)