Provider Demographics
NPI:1093755407
Name:STAR REHABLITATION PT, P.C.
Entity Type:Organization
Organization Name:STAR REHABLITATION PT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:HILTON
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-234-5175
Mailing Address - Street 1:41 PENNINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1419
Mailing Address - Country:US
Mailing Address - Phone:845-364-0499
Mailing Address - Fax:
Practice Address - Street 1:7610-7612 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2411
Practice Address - Country:US
Practice Address - Phone:718-234-5175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7W7N1Medicare PIN