Provider Demographics
NPI:1841091741
Name:COMMUNITY PHYSICAL THERAPY OF LONG ISLAND PC
Entity type:Organization
Organization Name:COMMUNITY PHYSICAL THERAPY OF LONG ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-458-8720
Mailing Address - Street 1:1045 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2157
Mailing Address - Country:US
Mailing Address - Phone:347-458-8720
Mailing Address - Fax:
Practice Address - Street 1:7402 GRAND AVE STE 3B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4127
Practice Address - Country:US
Practice Address - Phone:917-369-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty