Provider Demographics
NPI:1770034977
Name:RES PHYSICAL MEDICINE & REHABILITATION SERVICES, P.C.
Entity Type:Organization
Organization Name:RES PHYSICAL MEDICINE & REHABILITATION SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-681-4088
Mailing Address - Street 1:2560 WALDEN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4757
Mailing Address - Country:US
Mailing Address - Phone:716-681-4088
Mailing Address - Fax:716-681-4240
Practice Address - Street 1:2560 WALDEN AVE
Practice Address - Street 2:STE 104
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-681-4088
Practice Address - Fax:716-681-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251108-12081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty