Healthcare Provider Details

I. General information

NPI: 1275120149
Provider Name (Legal Business Name): RED CORE PTPTA AND REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 PITKIN AVE
BROOKLYN NY
11212-6604
US

IV. Provider business mailing address

PO BOX 780173
MASPETH NY
11378-0173
US

V. Phone/Fax

Practice location:
  • Phone: 718-509-9888
  • Fax: 718-509-6144
Mailing address:
  • Phone: 718-509-9888
  • Fax: 718-509-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: EDUARD KHO
Title or Position: MANAGING PARTNER
Credential:
Phone: 718-509-9888