Provider Demographics
NPI:1427331750
Name:REHABILITATION AND PHYSICAL THERAPY SPECIALIST PC
Entity type:Organization
Organization Name:REHABILITATION AND PHYSICAL THERAPY SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PASTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:917-476-3012
Mailing Address - Street 1:26 DELAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2012
Mailing Address - Country:US
Mailing Address - Phone:917-476-3012
Mailing Address - Fax:
Practice Address - Street 1:7 E 93RD ST
Practice Address - Street 2:SUITE 2-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0665
Practice Address - Country:US
Practice Address - Phone:917-476-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016506261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy