Provider Demographics
NPI:1174850580
Name:RJL PRODYNAMIC CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:RJL PRODYNAMIC CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADALOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-561-3120
Mailing Address - Street 1:8027 135TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1029
Mailing Address - Country:US
Mailing Address - Phone:347-561-3120
Mailing Address - Fax:347-561-3142
Practice Address - Street 1:8027 135TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1029
Practice Address - Country:US
Practice Address - Phone:347-561-3120
Practice Address - Fax:347-561-3142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RJL PRODYNAMIC CARE PHYSICAL THERAPY P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026709-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center