Provider Demographics
NPI:1467576645
Name:SOLIMAN, SAMAR MOHAMED (DPT)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:MOHAMED
Last Name:SOLIMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 RICHMOND ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2548
Mailing Address - Country:US
Mailing Address - Phone:718-351-2160
Mailing Address - Fax:718-667-7279
Practice Address - Street 1:2052 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:S.I.
Practice Address - State:NY
Practice Address - Zip Code:10306-2548
Practice Address - Country:US
Practice Address - Phone:718-351-2160
Practice Address - Fax:718-667-2166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022726-3225100000X
NY022726-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400017469Medicare PIN