MEDICARE: PIONEERS STEPS REHAB PT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	033753	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	033753	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1003328980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEERS STEPS REHAB PT PC

Provider Business Mailing Address
First Line	:	632 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2210
Country	:	US
Telephone Number	:	929-245-0631
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MEDHAT EL NAZER
Credential	:	DPT
Telephone Number	:	929-245-0631

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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