Provider Demographics
NPI:1588949747
Name:LEGEND REHABILITATION-ACUPUNCTURE & PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:LEGEND REHABILITATION-ACUPUNCTURE & PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAP
Authorized Official - Middle Name:C
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:PT LAC
Authorized Official - Phone:718-980-9888
Mailing Address - Street 1:1481 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2309
Mailing Address - Country:US
Mailing Address - Phone:718-980-9888
Mailing Address - Fax:718-980-1403
Practice Address - Street 1:1481 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2309
Practice Address - Country:US
Practice Address - Phone:718-980-9888
Practice Address - Fax:718-980-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001272-1320700000X
NY14071320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities