1871757088 NPI number — SANDS POINT MEDICAL REHAB LLC

Table of content: (NPI 1871757088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871757088 NPI number — SANDS POINT MEDICAL REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDS POINT MEDICAL REHAB LLC
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:
1871757088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12010 15TH AVE
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
COLLEGE POINT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11356-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-701-5949
Provider Business Mailing Address Fax Number:
718-701-5949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12010 15TH AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
COLLEGE POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11356-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-701-5949
Provider Business Practice Location Address Fax Number:
718-701-5949
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSARION
Authorized Official First Name:
RANDOLPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
718-701-5949

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  201787 , 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: 1134305311 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com