Organization
PREMIER PHYSICAL MEDICINE & REHABILITATION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJ TOLAT MD (MEDICAL DIRECTOR)
(516) 593-3030
Entity
Organization
Contact information
Practice address
56B MERRICK ROAD, VALLEYSTREAM, NY 11580
(516) 593-3030
Mailing address
56B MERRICK ROAD, VALLEYSTREAM, NY 11580
(516) 593-3030
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
207587
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02105008
—
NY
01
—
207587-7W
WORKER'S COMPENSATION
NY
Enumeration date
10/21/2008
Last updated
10/21/2008
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