NPIMap

Organization Active NPI

Moon Rehab PT PC

  • Physical Therapist
  • Corona, NY
National Provider Identifier
1114388931
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MOON REHAB PT PC
Practice address
3719 108TH St
Corona, NY 11368-4176
Phone
(718) 406-9032
Fax
(917) 745-1561
NPI assigned
Mar 8, 2016
Last updated
Dec 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Mr. Mahmoud El Sayed, DPTNPI 1447563945
Title
President
Phone
(718) 406-9032

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: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3719 108TH St
Corona, NY 11368-4176

Mailing address

1045 Chestnut St
Valley Stream, NY 11580-2157

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160406000557 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2062710197 Receives reassigned benefits from 7 practitioners
Practice locations: Elmhurst, NY; Flushing, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1114388931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 CHESTNUT ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115802157",
            "fax_number": "917-745-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 108TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684176",
            "telephone_number": "718-406-9032",
            "fax_number": "917-745-1561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOON REHAB PT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "EL SAYED",
        "authorized_official_first_name": "MAHMOUD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-406-9032",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.