Provider Demographics
NPI:1659756641
Name:HIGH LINE REHAB PT PC
Entity Type:Organization
Organization Name:HIGH LINE REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHAZLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-540-4740
Mailing Address - Street 1:3457 82ND ST # 1G1F
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2939
Mailing Address - Country:US
Mailing Address - Phone:718-540-4740
Mailing Address - Fax:718-732-2378
Practice Address - Street 1:3457 82ND ST # 1G1F
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2939
Practice Address - Country:US
Practice Address - Phone:718-540-4740
Practice Address - Fax:718-732-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty