Provider Demographics
NPI:1245563105
Name:RICHMOND ROAD PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:RICHMOND ROAD PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:718-667-2190
Mailing Address - Street 1:24 COLONIAL GDNS
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5404
Mailing Address - Country:US
Mailing Address - Phone:718-667-2190
Mailing Address - Fax:718-667-7279
Practice Address - Street 1:2052 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2548
Practice Address - Country:US
Practice Address - Phone:718-667-2190
Practice Address - Fax:718-667-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022726225100000X
NY014113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty