Provider Demographics
NPI:1356016364
Name:MAF REHAB PT PC
Entity Type:Organization
Organization Name:MAF REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIEVIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:EBORA FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-788-7818
Mailing Address - Street 1:3720 PRINCE ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4499
Mailing Address - Country:US
Mailing Address - Phone:347-788-7818
Mailing Address - Fax:
Practice Address - Street 1:3720 PRINCE ST STE 2F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4499
Practice Address - Country:US
Practice Address - Phone:347-788-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty