Provider Demographics
NPI:1326185281
Name:NEW YORK PHYSICAL THERAPY REHABILITATION SERVICES
Entity Type:Organization
Organization Name:NEW YORK PHYSICAL THERAPY REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERTINA
Authorized Official - Middle Name:TINA
Authorized Official - Last Name:KURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-297-2504
Mailing Address - Street 1:20814 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3231
Mailing Address - Country:US
Mailing Address - Phone:718-776-6209
Mailing Address - Fax:718-358-3837
Practice Address - Street 1:4004 BOWNE ST
Practice Address - Street 2:SUITE 1I
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6143
Practice Address - Country:US
Practice Address - Phone:718-539-3359
Practice Address - Fax:718-358-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0133001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY179580OtherELDERPLAN
NY0106601OtherORTHONET
NY02071570Medicaid
NY11303OtherMAGNACARE
NY2125145OtherVYTRA
NY6697335OtherGHI
NY168577POtherHIP
NY0106601OtherORTHONET
NY168577POtherHIP