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General NPI Number Information
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NPI Number | 1215733829
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Entity Type | Organization
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Legal Business Name | ROOSEVELET PT PC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 591 W MERRICK RD
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5119
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Country | US
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Telephone | 516-206-0100
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Fax | 516-206-0101
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Provider Business Mailing Address
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Address Line | 121 WINHAM AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4930
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Country | US
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Telephone | 631-318-3148
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Fax |
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Authorized Official
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Title or Position | PT
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Name | AMRO BARAKAT
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Credential |
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Telephone | 631-318-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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