Provider Demographics
NPI:1902139595
Name:VEGAS TREATMENT
Entity Type:Organization
Organization Name:VEGAS TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-888-9778
Mailing Address - Street 1:13621 ROOSEVELT AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5507
Mailing Address - Country:US
Mailing Address - Phone:718-888-9778
Mailing Address - Fax:718-799-5360
Practice Address - Street 1:13621 ROOSEVELT AVE STE 409
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5507
Practice Address - Country:US
Practice Address - Phone:718-888-9778
Practice Address - Fax:718-799-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty