Provider Demographics
NPI:1447262654
Name:REHABILITATION PHYSICAL THERAPY ASSOCIATES OF STATEN ISLAND, P.C.
Entity type:Organization
Organization Name:REHABILITATION PHYSICAL THERAPY ASSOCIATES OF STATEN ISLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-984-8400
Mailing Address - Street 1:4079 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5633
Mailing Address - Country:US
Mailing Address - Phone:718-984-8400
Mailing Address - Fax:718-984-8419
Practice Address - Street 1:4079 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5633
Practice Address - Country:US
Practice Address - Phone:718-984-8400
Practice Address - Fax:718-984-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7507261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0W051Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY0919080001Medicare NSC