Provider Demographics
NPI:1457670101
Name:COMPLETE REHAB MEDICINE CARE P.C.
Entity Type:Organization
Organization Name:COMPLETE REHAB MEDICINE CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOKAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVERGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-205-4911
Mailing Address - Street 1:250 S END AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1076
Mailing Address - Country:US
Mailing Address - Phone:718-205-4911
Mailing Address - Fax:718-205-5946
Practice Address - Street 1:130 WADSWORTH AVE APT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4823
Practice Address - Country:US
Practice Address - Phone:212-928-5959
Practice Address - Fax:212-928-5189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA S. NAVEDO RIVERA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190946208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60190946OtherLICENSE
NY01500669Medicaid
NY60190946OtherLICENSE