Provider Demographics
NPI:1710252762
Name:HEALTH TOWER PHYSICAL THERAPY P.C
Entity Type:Organization
Organization Name:HEALTH TOWER PHYSICAL THERAPY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EZZAT
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SHAABAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:347-866-5048
Mailing Address - Street 1:8402 4TH AVE
Mailing Address - Street 2:APT # C8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4657
Mailing Address - Country:US
Mailing Address - Phone:347-866-5048
Mailing Address - Fax:718-680-0236
Practice Address - Street 1:8402 4TH AVE
Practice Address - Street 2:APT # C8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4657
Practice Address - Country:US
Practice Address - Phone:347-866-5048
Practice Address - Fax:718-680-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017565261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health