Provider Demographics
NPI:1346073970
Name:SMI PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:SMI PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:MONTASER
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:925-673-9010
Mailing Address - Street 1:250 W 50TH ST APT 22F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6724
Mailing Address - Country:US
Mailing Address - Phone:925-408-3906
Mailing Address - Fax:
Practice Address - Street 1:1120 MORRIS PARK AVE STE 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1463
Practice Address - Country:US
Practice Address - Phone:718-684-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy