Provider Demographics
NPI:1083667109
Name:CRESCENT PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:CRESCENT PHYSICAL THERAPY P.C.
Other - Org Name:KHURRAM KHAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHURRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-685-5954
Mailing Address - Street 1:2124 30TH AVE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4189
Mailing Address - Country:US
Mailing Address - Phone:917-685-5954
Mailing Address - Fax:718-545-0999
Practice Address - Street 1:2124 30TH AVE
Practice Address - Street 2:SUITE C1
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4189
Practice Address - Country:US
Practice Address - Phone:917-685-5954
Practice Address - Fax:718-545-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0259752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6607395OtherGHI PPO