Provider Demographics
NPI:1720436769
Name:WILMER LACSON REHAB SERVICES,INC.
Entity Type:Organization
Organization Name:WILMER LACSON REHAB SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILMER
Authorized Official - Middle Name:AVANCY
Authorized Official - Last Name:LACSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-484-1465
Mailing Address - Street 1:315 E 108TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4245
Mailing Address - Country:US
Mailing Address - Phone:917-484-1465
Mailing Address - Fax:
Practice Address - Street 1:66 CRISFIELD ST
Practice Address - Street 2:UNIT 1Q
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1243
Practice Address - Country:US
Practice Address - Phone:917-484-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0157731261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy