Provider Demographics
NPI:1497905608
Name:KABIR, IMRUL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:IMRUL
Middle Name:
Last Name:KABIR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 169TH ST
Mailing Address - Street 2:APT 415
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2049
Mailing Address - Country:US
Mailing Address - Phone:718-314-6763
Mailing Address - Fax:347-923-3217
Practice Address - Street 1:16902 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2632
Practice Address - Country:US
Practice Address - Phone:718-314-6763
Practice Address - Fax:347-923-3217
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03427938Medicaid
NYG400065872Medicare PIN