Provider Demographics
NPI:1053855528
Name:SIMPLE REHAB PT PC
Entity Type:Organization
Organization Name:SIMPLE REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-902-4699
Mailing Address - Street 1:169 BAY 37TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5338
Mailing Address - Country:US
Mailing Address - Phone:347-902-4699
Mailing Address - Fax:
Practice Address - Street 1:169 BAY 37TH ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5338
Practice Address - Country:US
Practice Address - Phone:347-902-4699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty