Provider Demographics
NPI:1801013552
Name:PARKWAY MEDICAL & REHABILITATION, PC
Entity Type:Organization
Organization Name:PARKWAY MEDICAL & REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:MANGAHAS
Authorized Official - Last Name:CRUZ-BANTING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-944-6262
Mailing Address - Street 1:729 PELHAM PKWY N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9506
Mailing Address - Country:US
Mailing Address - Phone:718-944-6262
Mailing Address - Fax:718-944-6266
Practice Address - Street 1:729 PELHAM PKWY N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9506
Practice Address - Country:US
Practice Address - Phone:718-944-6262
Practice Address - Fax:718-944-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2125372081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW8C861Medicare ID - Type UnspecifiedOUTPATIENT CLINIC