Healthcare Provider Details

I. General information

NPI: 1053078170
Provider Name (Legal Business Name): NEW FORM PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 RALPH AVE
BROOKLYN NY
11236-3319
US

IV. Provider business mailing address

14004 ROCKINGHAM RD
GERMANTOWN MD
20874-2250
US

V. Phone/Fax

Practice location:
  • Phone: 718-649-6356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RINKU KURIL
Title or Position: OWNER, CEO
Credential: DPT, ECS, RMSK
Phone: 917-282-0238