Provider Demographics
NPI:1760728091
Name:ACCELERATED REHABILITATION AND PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ACCELERATED REHABILITATION AND PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-804-2299
Mailing Address - Street 1:127 MYLES AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1715
Mailing Address - Country:US
Mailing Address - Phone:631-804-2299
Mailing Address - Fax:
Practice Address - Street 1:87-10 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-507-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03436688Medicaid
NY03436688Medicaid