Provider Demographics
NPI:1700194446
Name:WARREN STREET ORTHOPEDIC REHABILITATION
Entity Type:Organization
Organization Name:WARREN STREET ORTHOPEDIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:HUMBERTO
Authorized Official - Last Name:SOTELO-GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-374-0102
Mailing Address - Street 1:51 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3509
Mailing Address - Country:US
Mailing Address - Phone:212-374-0102
Mailing Address - Fax:212-513-1618
Practice Address - Street 1:51 WARREN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3509
Practice Address - Country:US
Practice Address - Phone:212-374-0102
Practice Address - Fax:212-513-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136353207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty