Provider Demographics
NPI:1689321515
Name:KINGS REHABILITATION PT PC
Entity Type:Organization
Organization Name:KINGS REHABILITATION PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:929-253-1233
Mailing Address - Street 1:19 GRIGGS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1401
Mailing Address - Country:US
Mailing Address - Phone:929-253-1233
Mailing Address - Fax:
Practice Address - Street 1:68 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6705
Practice Address - Country:US
Practice Address - Phone:718-566-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy