Healthcare Provider Details

I. General information

NPI: 1013850866
Provider Name (Legal Business Name): EXCELSIOR PHYSICAL MEDICINE AND REHABILITATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 ROOSEVELT AVE
WOODSIDE NY
11377-4239
US

IV. Provider business mailing address

5314 ROOSEVELT AVE
WOODSIDE NY
11377-4239
US

V. Phone/Fax

Practice location:
  • Phone: 929-401-4961
  • Fax: 929-401-4962
Mailing address:
  • Phone: 929-401-4961
  • Fax: 929-401-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PENG ZHAO
Title or Position: DIRECTOR
Credential: MD
Phone: 718-206-7434