MEDICARE: PRINCE REHAB CARE 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	252Y00000X	Early Intervention Provider Agency	025553	NY

General Provider Information

NPI Number	:	1962642678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCE REHAB CARE PT PC

Provider Business Mailing Address
First Line	:	7004 3RD AVE
Second Line	:	3
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1307
Country	:	US
Telephone Number	:	718-680-0915
Fax Number	:	718-680-0915

Provider Business Practice Location Address
First Line	:	7004 3RD AVE
Second Line	:	3
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1307
Country	:	US
Telephone Number	:	718-680-0915
Fax Number	:	718-680-0915

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAYED A GOMAA
Credential	:
Telephone Number	:	718-680-0915

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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