Provider Demographics
NPI:1275550204
Name:NEW MILLENIUM REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:NEW MILLENIUM REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EZEQUIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-418-4108
Mailing Address - Street 1:5205 NW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4824
Mailing Address - Country:US
Mailing Address - Phone:305-418-4108
Mailing Address - Fax:305-418-4081
Practice Address - Street 1:5205 NW 74TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-4824
Practice Address - Country:US
Practice Address - Phone:305-418-4108
Practice Address - Fax:305-418-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686856Medicare ID - Type Unspecified