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NPI Code Detail

MEDICARE: IMPERIAL REHAB PT PC

MEDICARE: IMPERIAL 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
1225100000XPhysical Therapist032839NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1032839OTHERNYLICENSE

General Provider Information

NPI Number : 1730503178
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMPERIAL REHAB PT PC
Provider Business Mailing Address
First Line : 30 BAY 17TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-3706
Country : US
Telephone Number : 631-805-8655
Fax Number :
Provider Business Practice Location Address
First Line : 21808 HEMPSTEAD AVE
Second Line : 2 FL
City : QUEENS VILLAGE
State : NY
Zip : 11429-1235
Country : US
Telephone Number : 631-805-8655
Fax Number : 718-998-9059
Authorized Official
Title or Position : PRESIDENT
Name : KHALED AAGA
Credential : PT
Telephone Number : 631-805-8655
Provider Enumeration Date : 02/05/2014
Last Update Date : 02/05/2014

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