Provider Demographics
NPI:1669873329
Name:EZ PHYSICAL THERAPY REHABILITATION PC
Entity type:Organization
Organization Name:EZ PHYSICAL THERAPY REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBADA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-974-2518
Mailing Address - Street 1:408 77TH ST
Mailing Address - Street 2:#A3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 77TH ST
Practice Address - Street 2:#A3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3243
Practice Address - Country:US
Practice Address - Phone:631-974-2518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty