Provider Demographics
NPI:1992118962
Name:AMO PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:AMO PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:OMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-915-1966
Mailing Address - Street 1:131 ROME AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3149
Mailing Address - Country:US
Mailing Address - Phone:347-915-1966
Mailing Address - Fax:347-915-1967
Practice Address - Street 1:401 DITMAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4919
Practice Address - Country:US
Practice Address - Phone:347-915-1966
Practice Address - Fax:347-915-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021049208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty