Provider Demographics
NPI:1427563287
Name:ITALY REHAB PT PC
Entity Type:Organization
Organization Name:ITALY REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSAMELDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM PT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-909-8074
Mailing Address - Street 1:186 BAY 31ST ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5646
Mailing Address - Country:US
Mailing Address - Phone:347-909-8074
Mailing Address - Fax:
Practice Address - Street 1:235 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5303
Practice Address - Country:US
Practice Address - Phone:718-418-4700
Practice Address - Fax:718-418-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-02
Last Update Date:2017-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy