Prime Leader PT PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

35568 Issued in NY

Legal business name

PRIME LEADER PT PC

Practice address

139 N Central Ave
Valley Stream, NY 11580-3856

Phone

(516) 612-7288

NPI assigned

Feb 10, 2015

Organization subpart

No

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

Authorized official

Name

Ahmed Mohammed Moamen Ghanem, DPTNPI 1063832368

Title

Owner

Phone

(516) 612-7288

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

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

• Ahmed Mohammed Moamen Ghanem

  • Physical Therapist
  • Brooklyn, NY
  • NPI 1063832368
  Medicare reassignment Authorized official
• Osama Almanastirly, DPT

  • Orthopedic Physical Therapist
  • New York, NY
  • NPI 1023480290
  NPD (past)

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1568853786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8535 58TH AVE",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734811",
            "telephone_number": "929-333-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 N CENTRAL AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115803856",
            "telephone_number": "516-612-7288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME LEADER PT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "GHANEM",
        "authorized_official_first_name": "AHMED",
        "authorized_official_middle_name": "MOHAMMED MOAMEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-612-7288",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "35568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "35568",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Medical Supply
• Gigi Pressley
• Aaron Jed Barlis Presto, PT, DPT
• Jean-Paul Pretat
• Joshua Priesman
• Prime Living Care LLC
• Prime Plus Transit Inc
• Prince Center for the Visually Impaired
• Lucien Prince, MT
• Robin Prince

• Physical Therapist in Valley Stream, NY
• Providers in Valley Stream, 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 Feb 10, 2015; 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.