Provider Demographics
NPI:1205550860
Name:TRI BORO DRIVER REHABILITATION & MOBILITY SERVICES INC.
Entity type:Organization
Organization Name:TRI BORO DRIVER REHABILITATION & MOBILITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-916-2891
Mailing Address - Street 1:1642 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5808
Mailing Address - Country:US
Mailing Address - Phone:718-414-2457
Mailing Address - Fax:
Practice Address - Street 1:1642 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5808
Practice Address - Country:US
Practice Address - Phone:718-414-2457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty