PT Rehabilitation PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

022991 Issued in NY

Legal business name

PT REHABILITATION PC

Practice address

6393 Fitchett St
Rego Park, NY 11374-4830

Phone

(917) 846-9645

Fax

(718) 897-5162

NPI assigned

Jul 2, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Edward Mordukhay, RPTNPI 1811017569

Title

President

Phone

(917) 846-9645

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

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.

• Edward Mordukhay, PT

  • Physical Therapist
  • Rego Park, NY
  • NPI 1811017569
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356548457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6393 FITCHETT ST",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744830",
            "telephone_number": "917-846-9645",
            "fax_number": "718-897-5162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6393 FITCHETT ST",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744830",
            "telephone_number": "917-846-9645",
            "fax_number": "718-897-5162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORDUKHAY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-846-9645",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "022991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02623265",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cynthia M. Purcell, LMHC
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• Yi Qiu
• Qlimg Rego Park Woman's Health Med Office

• Physical Therapist in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.