Provider Demographics
NPI:1679768634
Name:ISLAND REHABILITATIVE SERVICES CORP.
Entity type:Organization
Organization Name:ISLAND REHABILITATIVE SERVICES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-987-5942
Mailing Address - Street 1:97 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2359
Mailing Address - Country:US
Mailing Address - Phone:718-448-5641
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:68 HAUPPAUGE RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4403
Practice Address - Country:US
Practice Address - Phone:718-448-5641
Practice Address - Fax:718-448-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332663Medicare Oscar/Certification