Provider Demographics
NPI:1285747667
Name:ACTIVE REHABILITATION AND CONDITIONING
Entity type:Organization
Organization Name:ACTIVE REHABILITATION AND CONDITIONING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ATC, CSCS
Authorized Official - Phone:212-281-6412
Mailing Address - Street 1:646 W 131ST ST
Mailing Address - Street 2:SUITE #301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7948
Mailing Address - Country:US
Mailing Address - Phone:212-281-6412
Mailing Address - Fax:
Practice Address - Street 1:646 W 131ST ST
Practice Address - Street 2:SUITE #301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7948
Practice Address - Country:US
Practice Address - Phone:212-281-6412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000780-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty