Provider Demographics
NPI:1497012314
Name:EMORY REHABILITATION SERVICE, INC.
Entity Type:Organization
Organization Name:EMORY REHABILITATION SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-848-3275
Mailing Address - Street 1:120 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1071
Mailing Address - Country:US
Mailing Address - Phone:732-254-8865
Mailing Address - Fax:732-254-8865
Practice Address - Street 1:12506 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2234
Practice Address - Country:US
Practice Address - Phone:718-848-3275
Practice Address - Fax:718-848-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013592-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528013893OtherNPI
NY1528013893OtherNPI