1952511701 NPI number — REHABILITATION AND PHYSICAL THERAPY CONSULTANT PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952511701 NPI number — REHABILITATION AND PHYSICAL THERAPY CONSULTANT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION AND PHYSICAL THERAPY CONSULTANT 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:
1952511701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 E 18TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-249-6501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1641 BERGEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-249-6501
Provider Business Practice Location Address Fax Number:
718-778-3083
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OKOME
Authorized Official First Name:
MUOYO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CLINICAL DIRECTOR
Authorized Official Telephone Number:
347-249-6501

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8361-1 , 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)

  • Identifier: AS 203 . This is a "OXFORD PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5714653 . This is a "FIRST HEALTH INS PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 77151 . This is a "CAREPLUS PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PRIS #20304P . This is a "HIP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0038950103 . This is a "HEALTHPLUS PROVIDERE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1841263423 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2326173 . This is a "AETNA PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6699117 . This is a "GHI PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 815353 . This is a "ACN GROUP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 008361S . This is a "HEATHCARE PARTNERS PRVD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00869397-001 . This is a "UNITED HEALTHCARE ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 008361NY . This is a "1199SEIU PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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