Healthcare Provider Details

I. General information

NPI: 1023258431
Provider Name (Legal Business Name): HOMESIDE REHAB, PT, OT, SLP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 ROUTE 306 STE 2
MONSEY NY
10952-1234
US

IV. Provider business mailing address

296 ROUTE 59 STE 12-25
AIRMONT NY
10901-5322
US

V. Phone/Fax

Practice location:
  • Phone: 718-377-5000
  • Fax: 718-377-5002
Mailing address:
  • Phone: 718-377-5000
  • Fax: 718-377-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016813
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number030125
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number016301
License Number StateNY

VIII. Authorized Official

Name: DR. YISROEL BRODY
Title or Position: DIRECTOR
Credential: DPT
Phone: 917-754-6634