Provider Demographics
NPI:1962673665
Name:REHAB ONE PC
Entity Type:Organization
Organization Name:REHAB ONE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-398-9600
Mailing Address - Street 1:1236 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2093
Mailing Address - Country:US
Mailing Address - Phone:718-398-9600
Mailing Address - Fax:718-398-9700
Practice Address - Street 1:1236 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2093
Practice Address - Country:US
Practice Address - Phone:718-398-9600
Practice Address - Fax:718-398-9700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHAB ONE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0W4R1OtherMEDICARE ID