Provider Demographics
NPI:1831318120
Name:INTEGRATED MEDICAL REHABILITAION & DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL REHABILITAION & DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-426-8177
Mailing Address - Street 1:18 GREENLAWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2926
Mailing Address - Country:US
Mailing Address - Phone:516-426-8177
Mailing Address - Fax:631-421-0786
Practice Address - Street 1:1 FULTON AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3646
Practice Address - Country:US
Practice Address - Phone:516-292-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165086261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG12669Medicare UPIN