Basic Information
| Provider Information | |||||||||
| NPI: | 1215958764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUTPATIENT REHAB. CENTERS OF N.Y. | ||||||||
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| OtherOrganizationName: | CENTER FOR REHABILITATION@BRONX | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2126 | ||||||||
| Address2: | |||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272892126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366276543 | ||||||||
| FaxNumber: | 3366276550 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 DREISER LOOP | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712955 | ||||||||
| FaxNumber: | 8885831285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 04/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | FERGUSON | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3366276543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | W34521 | 01 | NY | EMPIRE BCBS | OTHER |