NPIMap

Organization Active NPI

Optimal Rehabilitation OT&PT PLLC

  • Physical Therapist
  • Bronx, NY
National Provider Identifier
1003108358
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
031215 Issued in NY
Legal business name
OPTIMAL REHABILITATION OT&PT PLLC
Practice address
721 Melrose Ave
Bronx, NY 10455-1121
Phone
(917) 803-5276
Fax
(718) 762-1510
NPI assigned
May 4, 2011
Last updated
May 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Imanuel Fuzailov, DPTNPI 1235379827
Title
PT/Physical Therapist
Phone
(917) 803-5276

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 031215 NY Primary

Addresses

Primary practice location

721 Melrose Ave
Bronx, NY 10455-1121

Mailing address

16903 65TH Ave
Floor 2
Fresh Meadows, NY 11365-1923
Phone (917) 803-5276

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110901000164 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2264602135 Receives reassigned benefits from 3 practitioners
Practice locations: Bronx, NY; Woodhaven, NY; Jamaica, NY; Elmhurst, NY

National Provider Directory

National Provider Directory
Tax ID family
Optimal Rehabilitation Otpt2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1003108358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16903 65TH AVE",
            "address_2": "FLOOR 2",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651923",
            "telephone_number": "917-803-5276",
            "fax_number": "718-762-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 MELROSE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551121",
            "telephone_number": "917-803-5276",
            "fax_number": "718-762-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL REHABILITATION OT&PT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "FUZAILOV",
        "authorized_official_first_name": "IMANUEL",
        "authorized_official_title_or_position": "PT/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "917-803-5276",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.