Provider Demographics
NPI:1831568849
Name:REHAB 4 SHABAB PTPC
Entity type:Organization
Organization Name:REHAB 4 SHABAB PTPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMISE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:718-614-5700
Mailing Address - Street 1:9480 RIDGE BLVD APT 2K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6751
Mailing Address - Country:US
Mailing Address - Phone:718-748-6224
Mailing Address - Fax:
Practice Address - Street 1:77 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6718
Practice Address - Country:US
Practice Address - Phone:202-280-7019
Practice Address - Fax:855-790-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-20
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty