Provider Demographics
NPI:1710146857
Name:MID-ISLAND PHYSICAL MEDICINE AND REHABILITATION, P.C.
Entity Type:Organization
Organization Name:MID-ISLAND PHYSICAL MEDICINE AND REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-338-5182
Mailing Address - Street 1:15 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1001
Mailing Address - Country:US
Mailing Address - Phone:516-338-5182
Mailing Address - Fax:516-338-5184
Practice Address - Street 1:15 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1001
Practice Address - Country:US
Practice Address - Phone:516-338-5182
Practice Address - Fax:516-338-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163001208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty