MEDICARE: NORTH SHORE PHYSICAL THERAPY OF SI, 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	225100000X	Physical Therapist	016009-1	NY

General Provider Information

NPI Number	:	1558670836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE PHYSICAL THERAPY OF SI, PC

Provider Business Mailing Address
First Line	:	1146 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2407
Country	:	US
Telephone Number	:	718-356-1337
Fax Number	:	718-356-1337

Provider Business Practice Location Address
First Line	:	1216 BAY STREET
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305
Country	:	US
Telephone Number	:	718-356-1337
Fax Number	:	718-356-1337

Authorized Official
Title or Position	:	PART OWNER/PHYSICAL THERAPIST
Name	:	HAMMOUDA MAHMOUD SOLIMAN
Credential	:	PT
Telephone Number	:	917-538-6692

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	10/04/2010

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