NPIMap

Organization Active NPI

Rosedale Physical Therapy Rehabilitation

  • Physical Therapist
  • Rosedale, NY
National Provider Identifier
1215477492
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ROSEDALE PHYSICAL THERAPY REHABILITATION
Practice address
235-20 147TH Avenue
Suite 1
Rosedale, NY 11422-3226
Phone
(347) 733-1916
Fax
(718) 481-3358
NPI assigned
Mar 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Authorized official

Name
Mr. Kirolos Ezzat LabibNPI 1821498742
Title
PT
Phone
(347) 733-1916

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 MULTIPLE SINGLE SPECIALTY GROUP 225100000X NY Primary

Addresses

Primary practice location

235-20 147TH Avenue
Suite 1
Rosedale, NY 11422-3226

Mailing address

235-20 147TH Avenue
Suite 1
Rosedale, NY 11422-3226
Phone (347) 733-1916

Other names 1

  • Rosedale Physical Therapy Rehabilitation, PLLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171122002196 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1850658022 Receives reassigned benefits from 2 practitioners
Practice locations: Rosedale, NY

National Provider Directory

National Provider Directory

Locations

23520 147th Ave
Ste 1
Rosedale, NY 11422
Phone (347) 733-1916

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1215477492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235-20 147TH AVENUE",
            "address_2": "SUITE 1",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114223226",
            "telephone_number": "347-733-1916",
            "fax_number": "718-481-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235-20 147TH AVENUE",
            "address_2": "SUITE 1",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114223226",
            "telephone_number": "347-733-1916",
            "fax_number": "718-481-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEDALE PHYSICAL THERAPY REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-07",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "LABIB",
        "authorized_official_first_name": "KIROLOS",
        "authorized_official_middle_name": "EZZAT",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "347-733-1916",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosedale Physical Therapy Rehabilitation, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rosedale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.