Provider Demographics
NPI:1730810060
Name:NEW YORK EMG PT PC
Entity type:Organization
Organization Name:NEW YORK EMG PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELWAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-283-5068
Mailing Address - Street 1:205 MOSELY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4165
Mailing Address - Country:US
Mailing Address - Phone:347-283-5068
Mailing Address - Fax:
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4401
Practice Address - Country:US
Practice Address - Phone:917-930-2018
Practice Address - Fax:917-407-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty