1962459594 NPI number — TLC REHABILITATION PHYSICAL THERAPY PC

Table of content: (NPI 1962459594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962459594 NPI number — TLC REHABILITATION PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC REHABILITATION PHYSICAL THERAPY 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:
1962459594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 BAY PARKWAY
Provider Second Line Business Mailing Address:
C LEVEL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11204-3948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-238-9392
Provider Business Mailing Address Fax Number:
718-238-9379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41-61 KISSENA BLVD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-463-6335
Provider Business Practice Location Address Fax Number:
718-463-6087
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUI
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
KEUNG
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
718-463-6335

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03992 . This is a "MEDICARE-GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q9W301 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02350172 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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