Provider Demographics
NPI:1962610428
Name:BREEZY POINT PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:BREEZY POINT PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-945-7878
Mailing Address - Street 1:PO BOX 940068
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-0068
Mailing Address - Country:US
Mailing Address - Phone:718-945-7878
Mailing Address - Fax:
Practice Address - Street 1:11412 BEACH CHANNEL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2215
Practice Address - Country:US
Practice Address - Phone:718-945-7878
Practice Address - Fax:781-945-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07361Medicare ID - Type UnspecifiedGHI MEDICARE