Provider Demographics
NPI:1619206117
Name:REHAB1ONE OP LTD
Entity Type:Organization
Organization Name:REHAB1ONE OP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:MATATOV
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO
Authorized Official - Phone:718-961-2330
Mailing Address - Street 1:7721 166TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1232
Mailing Address - Country:US
Mailing Address - Phone:646-267-2409
Mailing Address - Fax:516-231-2732
Practice Address - Street 1:11411 JAMAICA AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2443
Practice Address - Country:US
Practice Address - Phone:718-961-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6382070001Medicare NSC