Provider Demographics
NPI:1033240106
Name:PHYSIO-REHAB, P.C.
Entity Type:Organization
Organization Name:PHYSIO-REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SEE-YIM
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-625-2528
Mailing Address - Street 1:17 ELIZABETH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-625-2528
Mailing Address - Fax:212-937-2015
Practice Address - Street 1:17 ELIZABETH ST STE 303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-625-2528
Practice Address - Fax:212-937-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01584770Medicaid
NY01584770Medicaid
NYQ02741Medicare UPIN