Provider Demographics
NPI:1790158129
Name:ST MARY FAMILY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ST MARY FAMILY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-258-7102
Mailing Address - Street 1:370 LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1008
Mailing Address - Country:US
Mailing Address - Phone:646-258-7102
Mailing Address - Fax:
Practice Address - Street 1:370 LARCH AVE
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1008
Practice Address - Country:US
Practice Address - Phone:646-258-7102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014906251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health