Basic Information
| Provider Information | |||||||||
| NPI: | 1366748477 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEI REHABILITATION SERVICE PT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5830 MAIN ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188868180 | ||||||||
| FaxNumber: | 7188868183 | ||||||||
| Practice Location | |||||||||
| Address1: | 5830 MAIN ST # LL | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188862820 | ||||||||
| FaxNumber: | 7188862120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2011 | ||||||||
| LastUpdateDate: | 02/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | RUFINO | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | RPT | ||||||||
| AuthorizedOfficialTelephone: | 7188862820 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 025629 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 025629 | 01 | NY | LICENSE | OTHER |