Provider Demographics
NPI:1376935676
Name:RECOVERY PT REHAB, PC
Entity Type:Organization
Organization Name:RECOVERY PT REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASNODIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIANALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-441-0362
Mailing Address - Street 1:15054 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15054 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1622
Practice Address - Country:US
Practice Address - Phone:718-880-2886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy