Provider Demographics
NPI:1841513967
Name:MEDICAL OUTPATIENT REHAB GWB
Entity type:Organization
Organization Name:MEDICAL OUTPATIENT REHAB GWB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAYEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-781-4720
Mailing Address - Street 1:436 FORT WASHINGTON AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3537
Mailing Address - Country:US
Mailing Address - Phone:212-781-4720
Mailing Address - Fax:212-923-9585
Practice Address - Street 1:436 FORT WASHINGTON AVE APT 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3537
Practice Address - Country:US
Practice Address - Phone:212-781-4720
Practice Address - Fax:212-923-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63448Medicare UPIN