Provider Demographics
NPI:1922339993
Name:DECHANG MEDICAL REHABILITATION P.C.
Entity Type:Organization
Organization Name:DECHANG MEDICAL REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:DENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-365-8989
Mailing Address - Street 1:3526 150TH PL
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4902
Mailing Address - Country:US
Mailing Address - Phone:718-939-3779
Mailing Address - Fax:718-939-3770
Practice Address - Street 1:3526 150TH PL
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4902
Practice Address - Country:US
Practice Address - Phone:718-939-3779
Practice Address - Fax:718-939-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02173628Medicaid
NYG96215Medicare UPIN
NY02173628Medicaid