Basic Information
| Provider Information | |||||||||
| NPI: | 1477970135 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISTA MEDICAL REHABILITATION P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 529 BEACH 20TH ST | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183277307 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187331000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2014 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | FAMILUSI | ||||||||
| AuthorizedOfficialFirstName: | ABIOLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 7183277307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.