Provider Demographics
NPI:1740291723
Name:REHABILITATION MEDICINE CONSULTANTS OF NY PLLC
Entity type:Organization
Organization Name:REHABILITATION MEDICINE CONSULTANTS OF NY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANGELINA
Authorized Official - Last Name:JOUVIN CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-239-5402
Mailing Address - Street 1:18436 HOVENDON RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2424
Mailing Address - Country:US
Mailing Address - Phone:718-239-5402
Mailing Address - Fax:718-430-7385
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3124
Practice Address - Country:US
Practice Address - Phone:718-239-5402
Practice Address - Fax:718-430-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216861261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02376332Medicaid
NYWEP561Medicare UPIN