Provider Demographics
NPI:1730321605
Name:TOTAL CARE & REHABILITATION MEDICINE PC
Entity Type:Organization
Organization Name:TOTAL CARE & REHABILITATION MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:KODSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:518-798-2225
Mailing Address - Street 1:5 MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-4067
Mailing Address - Country:US
Mailing Address - Phone:518-798-2225
Mailing Address - Fax:518-798-2807
Practice Address - Street 1:5 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-4067
Practice Address - Country:US
Practice Address - Phone:518-798-2225
Practice Address - Fax:518-798-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0101611111N00000X
NY239223208100000X
NY0253741261QP2000X
NY028558-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB3330Medicare UPIN
NYRB3332Medicare UPIN
NYRB3333Medicare UPIN
NYRB3331Medicare UPIN