1063623239 NPI number — UNIQUE REHAB PT P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063623239 NPI number — UNIQUE REHAB PT P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIQUE REHAB PT P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063623239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6976 JUNIPER BLVD S
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
MIDDLE VILLAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11379-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-806-3958
Provider Business Mailing Address Fax Number:
718-205-7004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6976 JUNIPER BLVD S
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
MIDDLE VILLAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11379-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-806-3958
Provider Business Practice Location Address Fax Number:
718-205-7004
Provider Enumeration Date:
05/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABDELATY
Authorized Official First Name:
ISLAM
Authorized Official Middle Name:
SHAFIK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-806-3958

Provider Taxonomy Codes

  • Taxonomy code: 320700000X , with the licence number:  027020-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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