Provider Demographics
NPI:1699239715
Name:MK SPINE AND JOINT REHAB, P.C.
Entity type:Organization
Organization Name:MK SPINE AND JOINT REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-335-9935
Mailing Address - Street 1:500 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1901
Mailing Address - Country:US
Mailing Address - Phone:516-757-4466
Mailing Address - Fax:631-940-1557
Practice Address - Street 1:500 OLD COUNTRY RD STE 300
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1944
Practice Address - Country:US
Practice Address - Phone:631-335-9935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain