Provider Demographics
NPI:1447474275
Name:MID-NASSAU PT
Entity type:Organization
Organization Name:MID-NASSAU PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHSHOUDEH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-520-8480
Mailing Address - Street 1:239 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1927
Mailing Address - Country:US
Mailing Address - Phone:718-520-8480
Mailing Address - Fax:
Practice Address - Street 1:10814 72ND AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5350
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015236-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141864POtherHIP
NYQ03D51OtherBCBS
NY6698072OtherGHI
NYQ03D51OtherBCBS
NY06558HMedicare PIN