# NEW YORK PHYSICAL MEDICINE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609135888
- **Authorized official:** LISA KEOUGH (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (405) 848-7974

## Contact information

- **Practice address:** 1295 PORTLAND AVE, STE 9, ROCHESTER, NY 14621-2731
- **Practice address phone:** (585) 544-6410
- **Practice address fax:** (585) 544-9247
- **Mailing address:** 1295 PORTLAND AVE, STE 9, ROCHESTER, NY 14621-2731
- **Mailing address phone:** (585) 544-6410
- **Mailing address fax:** (585) 544-9247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 239194 | NY | Yes |

## Other

- **Enumeration date:** 05/09/2012
- **Last updated:** 05/09/2012