Provider Demographics
NPI:1689969552
Name:RADWA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:RADWA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELMANDOUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-755-6680
Mailing Address - Street 1:230 BAY 22ND ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6106
Mailing Address - Country:US
Mailing Address - Phone:917-755-6680
Mailing Address - Fax:
Practice Address - Street 1:430 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3708
Practice Address - Country:US
Practice Address - Phone:718-748-6644
Practice Address - Fax:646-217-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030595261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy