Provider Demographics
NPI:1699205021
Name:NEW YORK REHAB PT.PC
Entity Type:Organization
Organization Name:NEW YORK REHAB PT.PC
Other - Org Name:NEW YORK REHAB PT.PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:HESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELWAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-283-5068
Mailing Address - Street 1:205 MOSELY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 RALPH PL STE 210
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4424
Practice Address - Country:US
Practice Address - Phone:917-930-2018
Practice Address - Fax:917-407-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035314261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy