Provider Demographics
NPI:1477570315
Name:EAST COAST REHABILITATION INC
Entity Type:Organization
Organization Name:EAST COAST REHABILITATION INC
Other - Org Name:COLUMBUS CENTER FOR MEDICAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-538-8343
Mailing Address - Street 1:1221 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3301
Mailing Address - Country:US
Mailing Address - Phone:718-538-8343
Mailing Address - Fax:718-538-8356
Practice Address - Street 1:1221 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3301
Practice Address - Country:US
Practice Address - Phone:718-538-8343
Practice Address - Fax:718-538-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220243225400000X
NY261QR0401X
NY220248332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WNW291Medicare PIN
5672660001Medicare PIN
417R42Medicare UPIN
5672660001Medicare NSC
NY334533Medicare Oscar/Certification