Provider Demographics
NPI:1104269349
Name:INTERVENTIONAL PHYSICAL MEDICINE & REHABILIATION, P.C.
Entity type:Organization
Organization Name:INTERVENTIONAL PHYSICAL MEDICINE & REHABILIATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-904-9400
Mailing Address - Street 1:PO BOX 9309
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-9309
Mailing Address - Country:US
Mailing Address - Phone:516-294-4590
Mailing Address - Fax:516-294-5185
Practice Address - Street 1:3227 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5707
Practice Address - Country:US
Practice Address - Phone:718-904-9400
Practice Address - Fax:718-904-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261232208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty