Provider Demographics
NPI:1952425381
Name:WALL STREET PHYSICAL MEDICINE & REHABILITATION, P.C.
Entity Type:Organization
Organization Name:WALL STREET PHYSICAL MEDICINE & REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-248-0077
Mailing Address - Street 1:61 BROADWAY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2701
Mailing Address - Country:US
Mailing Address - Phone:212-248-0077
Mailing Address - Fax:212-747-0939
Practice Address - Street 1:61 BROADWAY
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2701
Practice Address - Country:US
Practice Address - Phone:212-248-0077
Practice Address - Fax:212-747-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty