Provider Demographics
NPI:1861664500
Name:BROOKLYN PT & REHABILITATION, P.C.
Entity Type:Organization
Organization Name:BROOKLYN PT & REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:ELOKDA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-236-1050
Mailing Address - Street 1:8120 15TH AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3120
Mailing Address - Country:US
Mailing Address - Phone:718-236-1050
Mailing Address - Fax:718-236-1075
Practice Address - Street 1:8120 15TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3120
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:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty