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NPI Code Detail

MEDICARE: ST. PAVLY PT PC

MEDICARE: ST. PAVLY 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
1208100000XPhysical Medicine & Rehabilitation Physician028129NY

General Provider Information

NPI Number : 1932498458
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. PAVLY PT PC
Provider Business Mailing Address
First Line : 8800 20TH AVE
Second Line : APT. 3M
City : BROOKLYN
State : NY
Zip : 11214-4849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2955 BRIGHTON 4TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-8533
Country : US
Telephone Number : 347-587-6410
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MIKHAIL SALIB
Credential :
Telephone Number : 347-587-6410
Provider Enumeration Date : 04/05/2011
Last Update Date : 04/05/2011

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