# GJ, PHYSICAL THERAPIST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184091068
- **Authorized official:** DR. GHOLAMREZA JAHANARA DR OF PHYSICAL THERA (PRESIDENT)
- **Authorized official phone:** (646) 417-1300

## Contact information

- **Practice address:** 1822 CORPORAL KENNEDY ST, BAYSIDE, NY 11360-1447
- **Practice address phone:** (646) 417-1300
- **Mailing address:** 18-22 CORPORAL KENNEDY STREET, BAYSIDE, NY 11360
- **Mailing address phone:** (646) 417-1300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 019910-1 | NY | Yes |

## Other

- **Enumeration date:** 08/27/2015
- **Last updated:** 08/27/2015