Provider Demographics
NPI:1821222555
Name:ST. HERMINA PHYSICAL THERAPIST P.C.
Entity Type:Organization
Organization Name:ST. HERMINA PHYSICAL THERAPIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:FAHMY
Authorized Official - Last Name:TAWADROS DAWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-589-0684
Mailing Address - Street 1:12 MANDY CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1966
Mailing Address - Country:US
Mailing Address - Phone:917-589-0684
Mailing Address - Fax:718-236-1075
Practice Address - Street 1:1711 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3651
Practice Address - Country:US
Practice Address - Phone:718-236-1050
Practice Address - Fax:718-236-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-09
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY030332261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty