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General NPI Number Information
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NPI Number | 1518345719
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Entity Type | Organization
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Legal Business Name | MAIN CARE PT PC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 6241 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-3731
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Country | US
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Telephone | 718-769-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 6241 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-3731
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Country | US
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Telephone | 718-769-7878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EHAB ELSAYED
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Credential | PT,DPT
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Telephone | 718-769-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 026516
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 026516
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License Number State | NY
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