Provider Demographics
NPI:1366528861
Name:POST INJURY MEDICAL TREATMENT PC
Entity type:Organization
Organization Name:POST INJURY MEDICAL TREATMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-459-5556
Mailing Address - Street 1:PO BOX 750423
Mailing Address - Street 2:POST INJURY MEDICAL TREATMENT PC
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-459-5556
Mailing Address - Fax:
Practice Address - Street 1:17-31 SEAGIRT BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-471-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193766208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01484808Medicaid
NY01484808Medicaid
F83729Medicare UPIN