Provider Demographics
NPI:1558670836
Name:NORTH SHORE PHYSICAL THERAPY OF SI, PC
Entity Type:Organization
Organization Name:NORTH SHORE PHYSICAL THERAPY OF SI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HAMMOUDA
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-538-6692
Mailing Address - Street 1:1146 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2407
Mailing Address - Country:US
Mailing Address - Phone:718-356-1337
Mailing Address - Fax:718-356-1337
Practice Address - Street 1:1216 BAY STREET
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-356-1337
Practice Address - Fax:718-356-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016009-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty