1619256054 NPI number — MISSION REHAB PT PC

Table of content: (NPI 1619256054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619256054 NPI number — MISSION REHAB PT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION REHAB PT PC
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:
1619256054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6802 RIDGE BLVD, APT # 4M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-238-1562
Provider Business Mailing Address Fax Number:
718-238-1562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4256-2 BRONX BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-708-7007
Provider Business Practice Location Address Fax Number:
718-708-7004
Provider Enumeration Date:
08/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ABDEL-AAL
Authorized Official First Name:
NABIL
Authorized Official Middle Name:
MAHMOUD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
347-692-5949

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  030625 , 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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