Provider Demographics
NPI:1669924981
Name:SKYLINE PHYSICAL MEDICINE & REHABILITATION PC
Entity type:Organization
Organization Name:SKYLINE PHYSICAL MEDICINE & REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONFETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-294-4590
Mailing Address - Street 1:40 BROAD ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2315
Mailing Address - Country:US
Mailing Address - Phone:212-797-1200
Mailing Address - Fax:516-248-2380
Practice Address - Street 1:40 BROAD ST
Practice Address - Street 2:SUITE 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2315
Practice Address - Country:US
Practice Address - Phone:212-797-1200
Practice Address - Fax:516-248-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278621-12081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty