Provider Demographics
NPI:1053859207
Name:AMERICAN MEDICAL COMPANY
Entity Type:Organization
Organization Name:AMERICAN MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:ABDELAZIM
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-353-9379
Mailing Address - Street 1:260 MIDDLE COUNTRY RD
Mailing Address - Street 2:BUILDING 3 SUIT 9A
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2568
Mailing Address - Country:US
Mailing Address - Phone:631-732-1600
Mailing Address - Fax:
Practice Address - Street 1:1671 W 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1104
Practice Address - Country:US
Practice Address - Phone:718-975-6793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040926261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy