=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568326007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS RIDGE PT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1081 GATES AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11221-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-534-1251
-----------------------------------------------------
Fax | 347-812-0086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1565 W 11TH ST APT 1R
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-6245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-534-1251
-----------------------------------------------------
Fax | 347-812-0086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GROUP OWNER
-----------------------------------------------------
Name | HASSAN ELAGATY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 551-216-3148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------