Healthcare Provider Details

I. General information

NPI: 1497905608
Provider Name (Legal Business Name): IMRUL KABIR P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16902 HIGHLAND AVE
JAMAICA NY
11432-2632
US

IV. Provider business mailing address

8450 169TH ST APT 415
JAMAICA NY
11432-2049
US

V. Phone/Fax

Practice location:
  • Phone: 718-314-6763
  • Fax: 347-923-3217
Mailing address:
  • Phone: 718-314-6763
  • Fax: 347-923-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: