Basic Information
| Provider Information | |||||||||
| NPI: | 1982627113 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RJZM LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALL MED & REHABILITATION OF NEW YORK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2604 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104541199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182920100 | ||||||||
| FaxNumber: | 7188660163 | ||||||||
| Practice Location | |||||||||
| Address1: | 4377 BRONX BLVD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104661397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183250700 | ||||||||
| FaxNumber: | 7183251301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 06/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | SLINGSBY | ||||||||
| AuthorizedOfficialFirstName: | EILEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7182920100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RJZM LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 7000259R | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 02100810 | 05 | NY | MEDICAID |