Healthcare Provider Details

I. General information

NPI: 1619256054
Provider Name (Legal Business Name): MISSION REHAB PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256-2 BRONX BLVD
BRONX NY
10466
US

IV. Provider business mailing address

6802 RIDGE BLVD, APT # 4M
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 718-708-7007
  • Fax: 718-708-7004
Mailing address:
  • Phone: 718-238-1562
  • Fax: 718-238-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number030625
License Number StateNY

VIII. Authorized Official

Name: DR. NABIL MAHMOUD ABDEL-AAL
Title or Position: PRESIDENT
Credential: DPT
Phone: 347-692-5949