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General NPI Number Information
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NPI Number | 1235970666
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Entity Type | Organization
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Legal Business Name | EMPIRE STATE REHAB PT PC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 2386 JEROME AVE FL 2
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City | BRONX
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State | NY
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Zip | 10468-6401
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Country | US
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Telephone | 347-459-8493
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Fax |
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Provider Business Mailing Address
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Address Line | 412 PROSPECT AVE
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City | DUMONT
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State | NJ
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Zip | 07628-1404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AHMED GHANEM
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Credential | PT
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Telephone | 347-459-8493
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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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