Provider Demographics
NPI:1871766196
Name:ADVANCED REHABILITATION MEDICAL CARE ,PLLC
Entity type:Organization
Organization Name:ADVANCED REHABILITATION MEDICAL CARE ,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROKEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-332-0694
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-0489
Mailing Address - Country:US
Mailing Address - Phone:631-332-0694
Mailing Address - Fax:
Practice Address - Street 1:3716 73RD ST STE 202
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6216
Practice Address - Country:US
Practice Address - Phone:718-205-1720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02728949Medicaid
1488J1Medicare PIN