Provider Demographics
NPI:1881762516
Name:INTERNATIONAL REHAB MEDICAL OFFICE PC
Entity type:Organization
Organization Name:INTERNATIONAL REHAB MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/AUTHORIZED
Authorized Official - Prefix:DR
Authorized Official - First Name:JINGLING
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-312-5726
Mailing Address - Street 1:1775 BAYRIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:347-312-5726
Mailing Address - Fax:718-504-7308
Practice Address - Street 1:1775 BAYRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:347-312-5726
Practice Address - Fax:718-504-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
06290Medicare PIN