Provider Demographics
NPI:1760938088
Name:MATILDA ABIOLA REHAB CARE LLC
Entity Type:Organization
Organization Name:MATILDA ABIOLA REHAB CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:ABIMBOLA
Authorized Official - Last Name:ABIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-412-0190
Mailing Address - Street 1:1592 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5218
Mailing Address - Country:US
Mailing Address - Phone:917-412-0190
Mailing Address - Fax:866-230-0943
Practice Address - Street 1:1592 E91ST STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5218
Practice Address - Country:US
Practice Address - Phone:917-412-0190
Practice Address - Fax:866-230-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015651252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency