Provider Demographics
NPI:1598017352
Name:SMART REHAB PTPC
Entity Type:Organization
Organization Name:SMART REHAB PTPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL SAYED
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-998-3020
Mailing Address - Street 1:2639 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2407
Mailing Address - Country:US
Mailing Address - Phone:347-985-1111
Mailing Address - Fax:347-985-1110
Practice Address - Street 1:2049 70TH ST
Practice Address - Street 2:2 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5402
Practice Address - Country:US
Practice Address - Phone:347-695-6932
Practice Address - Fax:347-462-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
029267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
029267OtherLICENSE