Provider Demographics
NPI:1063998706
Name:ADVANCED REHAB MEDICINE, PLLC
Entity type:Organization
Organization Name:ADVANCED REHAB MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHNI
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-729-5808
Mailing Address - Street 1:9119 HWY 6
Mailing Address - Street 2:SUITE 230, #127
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:516-729-5808
Mailing Address - Fax:
Practice Address - Street 1:9119 HWY 6
Practice Address - Street 2:SUITE 230, #127
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:516-729-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ95292081P2900X
TXR5541208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty