Provider Demographics
NPI:1043636129
Name:ULTIMATE CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ULTIMATE CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:AFIFY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:646-331-7186
Mailing Address - Street 1:393 STOBE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5235
Mailing Address - Country:US
Mailing Address - Phone:646-331-7186
Mailing Address - Fax:718-667-1198
Practice Address - Street 1:4226 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4502
Practice Address - Country:US
Practice Address - Phone:347-591-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022598261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy