Provider Demographics
NPI:1699192476
Name:MODERN REHABILITATION TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:MODERN REHABILITATION TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SCHWING
Authorized Official - Suffix:
Authorized Official - Credentials:LPO CPO
Authorized Official - Phone:631-360-6400
Mailing Address - Street 1:1180 LINCOLN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2285
Mailing Address - Country:US
Mailing Address - Phone:631-360-6400
Mailing Address - Fax:631-360-6449
Practice Address - Street 1:1180 LINCOLN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2285
Practice Address - Country:US
Practice Address - Phone:631-360-6400
Practice Address - Fax:631-360-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4146880001Medicare NSC