Provider Demographics
NPI:1437470986
Name:OPTIMAL PHYSICAL MEDICINE AND REHABILITATION OF NEW YORK CITY PC.
Entity Type:Organization
Organization Name:OPTIMAL PHYSICAL MEDICINE AND REHABILITATION OF NEW YORK CITY PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LIHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-7122
Mailing Address - Street 1:4233 KISSENA BLVD
Mailing Address - Street 2:#1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3241
Mailing Address - Country:US
Mailing Address - Phone:718-888-7122
Mailing Address - Fax:718-888-7172
Practice Address - Street 1:4233 KISSENA BLVD
Practice Address - Street 2:#1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3241
Practice Address - Country:US
Practice Address - Phone:718-888-7122
Practice Address - Fax:718-888-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212598208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02234393Medicaid
NYH01495Medicare UPIN