Provider Demographics
NPI:1972953412
Name:ATLANTIC REHAB PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ATLANTIC REHAB PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAYOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-886-7569
Mailing Address - Street 1:248 HUSSON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3508
Mailing Address - Country:US
Mailing Address - Phone:917-886-7569
Mailing Address - Fax:
Practice Address - Street 1:810 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4176
Practice Address - Country:US
Practice Address - Phone:917-886-7569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty