Basic Information
| Provider Information | |||||||||
| NPI: | 1477570315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST COAST REHABILITATION INC | ||||||||
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| OtherOrganizationName: | COLUMBUS CENTER FOR MEDICAL REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 JEROME AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104523301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185388343 | ||||||||
| FaxNumber: | 7185388356 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 JEROME AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104523301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185388343 | ||||||||
| FaxNumber: | 7185388356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | FUTERMAN | ||||||||
| AuthorizedOfficialFirstName: | LEO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7185388343 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | 220243 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 332B00000X | 220248 | NY | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | 220248 | NY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 261QR0401X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
No ID Information.