Provider Demographics
NPI:1437399532
Name:PRO CARE PHYSICAL THERAPY GROUP PC
Entity Type:Organization
Organization Name:PRO CARE PHYSICAL THERAPY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO MARK
Authorized Official - Middle Name:CLEMENTE
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:917-774-1436
Mailing Address - Street 1:4111 30TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2913
Mailing Address - Country:US
Mailing Address - Phone:718-274-4400
Mailing Address - Fax:
Practice Address - Street 1:4111 30TH AVE STE C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2913
Practice Address - Country:US
Practice Address - Phone:718-274-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025676261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04255QOtherMEDICARE/GHI