Provider Demographics
NPI:1811266869
Name:ESSENTIAL REHAB PT PC
Entity type:Organization
Organization Name:ESSENTIAL REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:ABDELHADY
Authorized Official - Suffix:
Authorized Official - Credentials:BACHLOR DEGREE
Authorized Official - Phone:917-816-7459
Mailing Address - Street 1:46 CROFT PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6508
Mailing Address - Country:US
Mailing Address - Phone:718-442-5089
Mailing Address - Fax:718-442-5089
Practice Address - Street 1:17 W END AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4812
Practice Address - Country:US
Practice Address - Phone:718-484-8199
Practice Address - Fax:718-484-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030398261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03340907Medicaid
NYA400049277Medicare PIN