Provider Demographics
NPI:1659650349
Name:PRESTIGE REHABILITATION & OT PC
Entity Type:Organization
Organization Name:PRESTIGE REHABILITATION & OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:SAYED
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:917-443-5460
Mailing Address - Street 1:18 BAY 22ND ST
Mailing Address - Street 2:APT # 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3819
Mailing Address - Country:US
Mailing Address - Phone:917-443-5460
Mailing Address - Fax:718-934-2225
Practice Address - Street 1:2995 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8390
Practice Address - Country:US
Practice Address - Phone:718-934-3703
Practice Address - Fax:718-934-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty