Provider Demographics
NPI:1073889010
Name:LIFE QUALITY P.T P.C
Entity Type:Organization
Organization Name:LIFE QUALITY P.T P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:FEKRY
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-573-4309
Mailing Address - Street 1:11412 BEACH CHANNEL DR
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2212
Mailing Address - Country:US
Mailing Address - Phone:718-945-7878
Mailing Address - Fax:718-945-7879
Practice Address - Street 1:11412 BEACH CHANNEL DR
Practice Address - Street 2:SUITE # 6
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2212
Practice Address - Country:US
Practice Address - Phone:718-945-7878
Practice Address - Fax:718-945-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6696905OtherGHI PPO
NY02638580Medicaid
NYMA8417OtherATLANTIS/EASY CHOICE
NY1000065520OtherAFFINITY
NY10210162OtherAMERIGROUP
NY092282OtherGHI HMO
NY1000065520OtherAFFINITY
NY07361HMedicare PIN