Provider Demographics
NPI:1053732560
Name:GRAND REHAB MEDICAL
Entity type:Organization
Organization Name:GRAND REHAB MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-1478
Mailing Address - Street 1:1365 YORK AVE
Mailing Address - Street 2:SUITE P2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4035
Mailing Address - Country:US
Mailing Address - Phone:212-879-1478
Mailing Address - Fax:800-708-5537
Practice Address - Street 1:9 E 45TH ST
Practice Address - Street 2:6TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2425
Practice Address - Country:US
Practice Address - Phone:212-879-1478
Practice Address - Fax:800-708-5537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUM REHAB &WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238738208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02746472Medicaid