Healthcare Provider Details

I. General information

NPI: 1124564687
Provider Name (Legal Business Name): AF PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2583
US

IV. Provider business mailing address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2583
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2190
  • Fax: 718-667-7279
Mailing address:
  • Phone: 718-667-2190
  • Fax: 718-667-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018280
License Number StateNY

VIII. Authorized Official

Name: MR. IBRAHIM ABDELFATAH
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 917-945-5442