MEDICARE: GDB PHYSICAL THERAPY 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	261QP2000X	Physical Therapy Clinic/Center	016043	NY

General Provider Information

NPI Number	:	1679946578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GDB PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	2124 LURTING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1214
Country	:	US
Telephone Number	:	718-344-6089
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-5704
Country	:	US
Telephone Number	:	718-344-6089
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	GILRAY BANAWIS
Credential	:	PT
Telephone Number	:	718-344-6089

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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