Provider Demographics
NPI:1114042017
Name:EXCELLENCE REHAB & PHYSICAL THERAPY,PC
Entity Type:Organization
Organization Name:EXCELLENCE REHAB & PHYSICAL THERAPY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN GLORIA
Authorized Official - Middle Name:ALONSO
Authorized Official - Last Name:RUIZ DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-518-1133
Mailing Address - Street 1:1894 EASTCHESTER RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2328
Mailing Address - Country:US
Mailing Address - Phone:718-518-1133
Mailing Address - Fax:718-518-1244
Practice Address - Street 1:1894 EASTCHESTER RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2328
Practice Address - Country:US
Practice Address - Phone:718-518-1133
Practice Address - Fax:718-518-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02324014Medicaid
NY02324014Medicaid