Basic Information
| Provider Information | |||||||||
| NPI: | 1417214966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANTER PHYSICAL MEDICINE & REHAB PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10509 JAMAICA AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184413211 | ||||||||
| FaxNumber: | 7184413744 | ||||||||
| Practice Location | |||||||||
| Address1: | 10509 JAMAICA AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184413211 | ||||||||
| FaxNumber: | 7184413744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | KANTER | ||||||||
| AuthorizedOfficialFirstName: | MIRIAM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES | ||||||||
| AuthorizedOfficialTelephone: | 7184413211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 196026-1 | 01 | NY | STATE LICENSE | OTHER |