Provider Demographics
NPI:1952524290
Name:ADVANCE CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADVANCE CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-255-8255
Mailing Address - Street 1:6360 98TH ST
Mailing Address - Street 2:STE A3
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6360 98TH ST
Practice Address - Street 2:STE A3
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2238
Practice Address - Country:US
Practice Address - Phone:718-664-0590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0570ALMedicare ID - Type Unspecified