Provider Demographics
NPI:1386330454
Name:IH REHAB PT PC
Entity type:Organization
Organization Name:IH REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWIDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,DSC,OCS,MSPT
Authorized Official - Phone:646-725-4026
Mailing Address - Street 1:1443 73RD ST # 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2111
Mailing Address - Country:US
Mailing Address - Phone:646-725-4026
Mailing Address - Fax:
Practice Address - Street 1:17004 HENLEY RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2786
Practice Address - Country:US
Practice Address - Phone:646-725-4026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy