Provider Demographics
NPI:1932510625
Name:INNOVATIVE PHYSICAL MEDICINE & REHAB PC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL MEDICINE & REHAB PC
Other - Org Name:INNOVATIVE P.M. & R., PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES. / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-667-4399
Mailing Address - Street 1:5 STEVENS AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2002
Mailing Address - Country:US
Mailing Address - Phone:914-667-4399
Mailing Address - Fax:914-667-4471
Practice Address - Street 1:5 STEVENS AVE FL 3
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2002
Practice Address - Country:US
Practice Address - Phone:914-667-4399
Practice Address - Fax:914-667-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175176-7208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty