Provider Demographics
NPI:1730511478
Name:PRO-CARE MEDICAL REHABILITATION P.C.
Entity type:Organization
Organization Name:PRO-CARE MEDICAL REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAKO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:718-848-3275
Mailing Address - Street 1:120 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1071
Mailing Address - Country:US
Mailing Address - Phone:732-254-8865
Mailing Address - Fax:732-254-8865
Practice Address - Street 1:13704 GUY BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434
Practice Address - Country:US
Practice Address - Phone:718-848-3275
Practice Address - Fax:718-848-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013592-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty