Provider Demographics
NPI:1215448022
Name:NY MOBILE REHAB LLC
Entity type:Organization
Organization Name:NY MOBILE REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-373-5913
Mailing Address - Street 1:11044 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13829 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-2641
Practice Address - Country:US
Practice Address - Phone:917-470-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NY MOBILE REHAB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care