Provider Demographics
NPI:1013206358
Name:HILLSIDE PHYSICAL MEDICINE & REHABILITATION PC
Entity Type:Organization
Organization Name:HILLSIDE PHYSICAL MEDICINE & REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-343-9100
Mailing Address - Street 1:6 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1112
Mailing Address - Country:US
Mailing Address - Phone:718-251-4878
Mailing Address - Fax:718-968-0573
Practice Address - Street 1:25913 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1622
Practice Address - Country:US
Practice Address - Phone:718-343-9100
Practice Address - Fax:718-343-9101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHA DUA PHYSICIAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215740-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy