Provider Demographics
NPI:1962799361
Name:MANJOORSA PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:MANJOORSA PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJOORSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-968-8304
Mailing Address - Street 1:8411 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3098
Mailing Address - Country:US
Mailing Address - Phone:347-968-8304
Mailing Address - Fax:
Practice Address - Street 1:8411 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3098
Practice Address - Country:US
Practice Address - Phone:347-968-8304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027648261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy