Provider Demographics
NPI:1649005778
Name:PRESTIGE REHAB NY LLC
Entity type:Organization
Organization Name:PRESTIGE REHAB NY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REIZIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-670-7573
Mailing Address - Street 1:16 W 16TH ST APT 4PN
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-0173
Mailing Address - Country:US
Mailing Address - Phone:855-678-8887
Mailing Address - Fax:855-678-8887
Practice Address - Street 1:16 W 16TH ST APT 4PN
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-0173
Practice Address - Country:US
Practice Address - Phone:855-678-8887
Practice Address - Fax:855-678-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty