Provider Demographics
NPI:1750421335
Name:8TH AVE PHYSICAL MEDICINE P.C.
Entity type:Organization
Organization Name:8TH AVE PHYSICAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-765-1788
Mailing Address - Street 1:743 58TH ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3916
Mailing Address - Country:US
Mailing Address - Phone:718-765-1788
Mailing Address - Fax:718-765-1789
Practice Address - Street 1:743 58TH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3916
Practice Address - Country:US
Practice Address - Phone:718-765-1788
Practice Address - Fax:718-765-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228967208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WWS871OtherMEDICARE