Provider Demographics
NPI:1699813758
Name:PHYSICAL MEDICINE & REHABILITATION SVCS. OF NY P.C.
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE & REHABILITATION SVCS. OF NY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORSUVILLE
Authorized Official - Middle Name:GUIANG
Authorized Official - Last Name:CABATU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-456-1267
Mailing Address - Street 1:1418 ROUTE 300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-566-4202
Mailing Address - Fax:845-566-4238
Practice Address - Street 1:1418 ROUTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-566-4202
Practice Address - Fax:845-566-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205-305261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02212499Medicaid
NY02212499Medicaid
NY71Z051Medicare ID - Type Unspecified
NY71Z051Medicare PIN