Healthcare Provider Details

I. General information

NPI: 1245563105
Provider Name (Legal Business Name): RICHMOND ROAD PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2548
US

IV. Provider business mailing address

24 COLONIAL GDNS
BROOKLYN NY
11209-5404
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 TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014113
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number022726
License Number StateNY

VIII. Authorized Official

Name: DR. SAMAR MOHAMED SOLIMAN
Title or Position: PARTNER
Credential: L.P.T.
Phone: 718-667-2190