MEDICARE: JONA CARE PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1063784866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONA CARE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	107 ORMSBY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-4040
Country	:	US
Telephone Number	:	917-776-6079
Fax Number	:	718-698-1016

Provider Business Practice Location Address
First Line	:	107 ORMSBY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-4040
Country	:	US
Telephone Number	:	917-776-6079
Fax Number	:	718-698-1016

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HANY MEKHAEL MEKHAEL
Credential	:	DPT
Telephone Number	:	917-776-6079

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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