Provider Demographics
NPI:1841862349
Name:CORE CARE PT PC
Entity type:Organization
Organization Name:CORE CARE PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-575-2488
Mailing Address - Street 1:8105 QUEENS BLVD # S2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3750
Mailing Address - Country:US
Mailing Address - Phone:347-224-7777
Mailing Address - Fax:
Practice Address - Street 1:8105 QUEENS BLVD # S2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3750
Practice Address - Country:US
Practice Address - Phone:347-224-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center