Provider Demographics
NPI:1225351091
Name:SCORE REHABILITATION PT PC
Entity Type:Organization
Organization Name:SCORE REHABILITATION PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:646-265-1334
Mailing Address - Street 1:2307 30TH DR # 1B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3251
Mailing Address - Country:US
Mailing Address - Phone:646-265-1334
Mailing Address - Fax:917-832-6795
Practice Address - Street 1:2307 30TH DR # 1B
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3251
Practice Address - Country:US
Practice Address - Phone:646-265-1334
Practice Address - Fax:917-832-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029386251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health