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General NPI Number Information
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NPI Number | 1154869543
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Entity Type | Organization
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Legal Business Name | SOUTH NASSAU PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 230 HILTON AVE SUITE 19 AND 20
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City | HEMPSTEAD
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State | NY
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Zip | 11550-8115
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Country | US
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Telephone | 516-307-9166
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Fax | 516-307-9165
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Provider Business Mailing Address
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Address Line | 230 HILTON AVE SUITE 19 AND 20
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City | HEMPSTEAD
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State | NY
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Zip | 11550-8115
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Country | US
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Telephone | 516-307-9166
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Fax | 516-307-9165
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SABAA MUNDIA
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Credential | DPT
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Telephone | 516-307-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 029592
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License Number State | NY
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