Provider Demographics
NPI:1699205021
Name:NEW YORK REHAB PT PC
Entity type:Organization
Organization Name:NEW YORK REHAB PT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:HESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELWAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-283-5068
Mailing Address - Street 1:205 MOSELY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5303
Practice Address - Country:US
Practice Address - Phone:718-418-4700
Practice Address - Fax:914-407-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035314261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy