Provider Demographics
NPI:1609906114
Name:42ND STREET PHYSICAL MEDICINE & REHABILITAION,P.C.
Entity Type:Organization
Organization Name:42ND STREET PHYSICAL MEDICINE & REHABILITAION,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-370-5551
Mailing Address - Street 1:120 E 42ND ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5678
Mailing Address - Country:US
Mailing Address - Phone:212-370-5551
Mailing Address - Fax:212-370-5559
Practice Address - Street 1:120 E 42ND ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5678
Practice Address - Country:US
Practice Address - Phone:212-370-5551
Practice Address - Fax:212-370-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203547225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty