Healthcare Provider Details

I. General information

NPI: 1831977370
Provider Name (Legal Business Name): ISLAND CARE PT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 ATLANTIC AVE
STATEN ISLAND NY
10304-4002
US

IV. Provider business mailing address

87 ATLANTIC AVE
STATEN ISLAND NY
10304-4002
US

V. Phone/Fax

Practice location:
  • Phone: 929-485-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAITHAM SALLAM
Title or Position: DPT
Credential:
Phone: 718-666-0267