Provider Demographics
NPI:1750468831
Name:PHYSICIANS MEDICAL REHABILITATION ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL REHABILITATION ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VLATTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-229-7800
Mailing Address - Street 1:213-16 39TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:718-229-7800
Mailing Address - Fax:718-279-7470
Practice Address - Street 1:21316 39TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2045
Practice Address - Country:US
Practice Address - Phone:718-229-7800
Practice Address - Fax:718-279-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty