Provider Demographics
NPI:1700932944
Name:GARDEN CITY PHYSICAL MEDICINE AND REHABILITATION, PC
Entity Type:Organization
Organization Name:GARDEN CITY PHYSICAL MEDICINE AND REHABILITATION, PC
Other - Org Name:CENTRAL ISLAND PHYSICAL MEDICINE AND REHABILITATION, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-877-0011
Mailing Address - Street 1:292A HERRICKS RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1119
Mailing Address - Country:US
Mailing Address - Phone:516-877-0011
Mailing Address - Fax:
Practice Address - Street 1:292A HERRICKS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1119
Practice Address - Country:US
Practice Address - Phone:516-877-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382032081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX101Medicare ID - Type UnspecifiedGROUP #