=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013230697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORNING STAR PHYSICAL THERAPY P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2010
-----------------------------------------------------
Last Update Date | 03/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77-16 164 STREET
-----------------------------------------------------
City | FRESH MEADOWS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-969-6100
-----------------------------------------------------
Fax | 718-969-6103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77-16 164 STREET
-----------------------------------------------------
City | FRESH MEADOWS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-969-6100
-----------------------------------------------------
Fax | 718-969-6103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MOHAMED Y ELSAIDY
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 718-969-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 026231
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------