Provider Demographics
NPI:1508929274
Name:REHABILITATION
Entity Type:Organization
Organization Name:REHABILITATION
Other - Org Name:MITCHELL MARTIN
Other - Org Type:Other Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTEI
Authorized Official - Suffix:I
Authorized Official - Credentials:OTA
Authorized Official - Phone:917-470-7040
Mailing Address - Street 1:210 E 102ND ST
Mailing Address - Street 2:#13H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5937
Mailing Address - Country:US
Mailing Address - Phone:212-876-0659
Mailing Address - Fax:212-876-0659
Practice Address - Street 1:210 E 102ND ST
Practice Address - Street 2:#13H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5937
Practice Address - Country:US
Practice Address - Phone:212-876-0659
Practice Address - Fax:212-876-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003295-1320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003295-1OtherLICENSURE