Provider Demographics
NPI:1487794640
Name:LONG ISLAND PHYSICAL REHABILITATION & SPORTS MEDICINE
Entity type:Organization
Organization Name:LONG ISLAND PHYSICAL REHABILITATION & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-326-1950
Mailing Address - Street 1:444 LAKEVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1165
Mailing Address - Country:US
Mailing Address - Phone:516-326-1950
Mailing Address - Fax:516-326-2950
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1165
Practice Address - Country:US
Practice Address - Phone:516-326-1950
Practice Address - Fax:516-326-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191224208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777393Medicaid
NY54H613Medicare PIN
NYF54489Medicare UPIN
NY01777393Medicaid