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General NPI Number Information
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NPI Number | 1699532226
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Entity Type | Organization
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Legal Business Name | GREENRIDGE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 3247 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2123
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Country | US
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Telephone | 718-663-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 3247 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2123
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Country | US
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Telephone | 646-750-4949
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/CEO
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Name | YEHIA ABOUELYOUSR MOHAMED
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Credential |
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Telephone | 718-285-2706
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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 |
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License Number State |
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