Organization
CITIMED 360 PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATYANA RABINOVICH (ADMINISTRATOR)
(718) 509-9424
Entity
Organization
Contact information
Practice address
1963 GRAND CONCOURSE FL 2, BRONX, NY 10453-4995
(718) 466-4600
Mailing address
9901 63RD RD, REGO PARK, NY 11374-1939
(718) 509-9424
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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