Provider Demographics
NPI:1912112566
Name:VERRAZANO PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:VERRAZANO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:BAYOMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-630-1290
Mailing Address - Street 1:6911 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1101
Mailing Address - Country:US
Mailing Address - Phone:718-630-1290
Mailing Address - Fax:718-630-1291
Practice Address - Street 1:6911 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1101
Practice Address - Country:US
Practice Address - Phone:718-630-1290
Practice Address - Fax:718-630-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0144721225100000X
NY0140801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528019197OtherPROVIDER NPI
NY01743580Medicaid
NY02738636Medicaid
NY1851343016OtherPROVIDER NPI
NYA100000227Medicare PIN
NY1528019197OtherPROVIDER NPI
NYQ32R41Medicare PIN