Healthcare Provider Details

I. General information

NPI: 1376835843
Provider Name (Legal Business Name): MIZRAIM PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277B BURNSIDE AVE
LAWRENCE NY
11559-1144
US

IV. Provider business mailing address

263 ADAMS ST
PISCATAWAY NJ
08854-3135
US

V. Phone/Fax

Practice location:
  • Phone: 732-586-6693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number032513
License Number StateNY

VIII. Authorized Official

Name: RIMOUN HANNA
Title or Position: CEO
Credential: DOCTORAL
Phone: 732-586-6693