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General NPI Number Information
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NPI Number | 1144915026
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Entity Type | Organization
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Legal Business Name | QUEENS ORTHOPPEDIC CARE PT PC
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 632 UTICA AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-2210
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Country | US
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Telephone | 929-575-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 6564 ELLWELL CRES
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City | REGO PARK
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State | NY
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Zip | 11374-5032
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Country | US
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Telephone | 929-575-2488
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAHMOUD MOHAMED
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Credential | PT, DPT , PHD, OCS
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Telephone | 929-575-2488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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