Provider Demographics
NPI:1326430539
Name:BRIGHT STAR REHAB PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BRIGHT STAR REHAB PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ELSAIDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-307-1509
Mailing Address - Street 1:4025 74TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5603
Mailing Address - Country:US
Mailing Address - Phone:718-280-1137
Mailing Address - Fax:
Practice Address - Street 1:4025 74TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5603
Practice Address - Country:US
Practice Address - Phone:718-280-1137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty