Provider Demographics
NPI:1598749277
Name:B.D. MANUAL REHAB PHYSICAL THERAPY
Entity Type:Organization
Organization Name:B.D. MANUAL REHAB PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-739-4583
Mailing Address - Street 1:166 BEACH 127TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1727
Mailing Address - Country:US
Mailing Address - Phone:347-739-4583
Mailing Address - Fax:718-228-2560
Practice Address - Street 1:3099 CONEY ISLAND AVE
Practice Address - Street 2:3-RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6305
Practice Address - Country:US
Practice Address - Phone:347-739-4583
Practice Address - Fax:718-228-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023288261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy