Provider Demographics
NPI:1710072707
Name:SLR REHABILITATION MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:SLR REHABILITATION MEDICINE ASSOCIATES
Other - Org Name:YOUNG SIE KWON
Other - Org Type:Other Name
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SEI
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-523-6607
Mailing Address - Street 1:1000 TENTH AVENUE
Mailing Address - Street 2:SUITE 3B-20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-523-6607
Mailing Address - Fax:212-526-8262
Practice Address - Street 1:1000 TENTH AVENUE
Practice Address - Street 2:SUITE 3B-20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-523-6607
Practice Address - Fax:212-526-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00596612Medicaid
NY39D071Medicare ID - Type UnspecifiedYOUNG SEI KOWN, MD
NY00596612Medicaid
NYC09559Medicare UPIN