Provider Demographics
NPI:1003341694
Name:MYOCARE PT P.C.
Entity Type:Organization
Organization Name:MYOCARE PT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-485-6000
Mailing Address - Street 1:87 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4002
Mailing Address - Country:US
Mailing Address - Phone:929-485-6000
Mailing Address - Fax:929-210-7000
Practice Address - Street 1:87 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4002
Practice Address - Country:US
Practice Address - Phone:929-485-6000
Practice Address - Fax:929-210-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty