Provider Demographics
NPI:1447584016
Name:PARK SLOPE REHAB PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PARK SLOPE REHAB PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BAYOMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-768-3349
Mailing Address - Street 1:6911 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1101
Mailing Address - Country:US
Mailing Address - Phone:718-630-1290
Mailing Address - Fax:718-630-1291
Practice Address - Street 1:557 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5431
Practice Address - Country:US
Practice Address - Phone:718-768-3349
Practice Address - Fax:718-768-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014472225100000X
NY014080225100000X
NY0148911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty