Provider Demographics
NPI:1629258991
Name:NEW YORK REHABILITATIVE SERVICES
Entity Type:Organization
Organization Name:NEW YORK REHABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NADATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-239-0990
Mailing Address - Street 1:214 E SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1315
Mailing Address - Country:US
Mailing Address - Phone:516-239-0990
Mailing Address - Fax:516-239-6555
Practice Address - Street 1:214 E SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1315
Practice Address - Country:US
Practice Address - Phone:516-239-0990
Practice Address - Fax:516-239-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02595480Medicaid
NY02595480Medicaid