Provider Demographics
NPI:1083797393
Name:THE WINIFRED MASTERSON BURKE REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:THE WINIFRED MASTERSON BURKE REHABILITATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-597-2232
Mailing Address - Street 1:785 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:785 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2523
Practice Address - Country:US
Practice Address - Phone:914-597-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2021-01-22
Deactivation Date:2020-09-10
Deactivation Code:
Reactivation Date:2020-12-15
Provider Licenses
StateLicense IDTaxonomies
NY5902002H282N00000X
283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW70551Medicare PIN