Provider Demographics
NPI:1033123039
Name:JGB REHABILITATION CORPORATION
Entity Type:Organization
Organization Name:JGB REHABILITATION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROGRAM AND SERVICES OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-769-6247
Mailing Address - Street 1:250 WEST 64TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-769-6313
Mailing Address - Fax:212-769-7825
Practice Address - Street 1:250 WEST 64TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-769-6313
Practice Address - Fax:212-769-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002131R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01061105Medicaid
NY01061105Medicaid