Provider Demographics
NPI:1114388931
Name:MOON REHAB PT PC
Entity Type:Organization
Organization Name:MOON REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:EL SAYED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-406-9032
Mailing Address - Street 1:1045 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:917-745-1561
Practice Address - Street 1:3719 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4176
Practice Address - Country:US
Practice Address - Phone:718-406-9032
Practice Address - Fax:917-745-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty