Optimal Rehabilitation OT & PT, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

031215 Issued in NY

Legal business name

OPTIMAL REHABILITATION OT & PT, PLLC

Doing business as

Optimal Rehabilitation OT & PT, PLLC

Practice address

721 Melrose Ave
Bronx, NY 10455-1121

Phone

(718) 554-0064

Fax

(718) 554-0221

NPI assigned

Nov 12, 2015

Last updated

Aug 23, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

OPTIMAL REHABILITATION OT & PT, PLLCAs reported in NPPES

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

Owner

Phone

(917) 803-5276

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• OPTIMAL REHABILITATION OT & PT, PLLC Doing business as

Tax ID family

Optimal Rehabilitation Otpt2 organizations share this tax ID, including this one

Part of

Optimal Rehabilitation Otpt

Other organizations with this tax ID 1

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

• Optimal Rehabilitation OT&PT PLLC

  • Physical Therapist
  • Bronx, NY
  • NPI 1003108358
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Optimal Rehabilitation OT&PT PLLC

  • Physical Therapist
  • Bronx, NY
  • NPI 1003108358
  NPPES parent name

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.

• Imanuel Fuzailov, PT

  • Physical Therapist
  • Bronx, NY
  • NPI 1235379827
  NPD Authorized official

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598140800000",
    "number": "1821461864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 MELROSE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551121",
            "telephone_number": "718-554-0064",
            "fax_number": "718-544-0221"
        },
        {
            "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": "718-554-0064",
            "fax_number": "718-554-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL REHABILITATION OT & PT, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTIMAL REHABILITATION OT & PT, PLLC",
        "enumeration_date": "2015-11-12",
        "last_updated": "2020-08-23",
        "certification_date": "2020-08-23",
        "status": "A",
        "authorized_official_last_name": "FUZAILOV",
        "authorized_official_first_name": "IMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-803-5276",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "031215",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "013231",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03381106",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIMAL REHABILITATION OT & PT, PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OPTIMAL REHABILITATION OT & PT, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Bronx, NY
• Providers in Bronx, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.