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Organization
MID-NASSAU PT
Active
Organization
MID-NASSAU PT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAMAK BAKHSHOUDEH PT (PRESIDENT)
(718) 520-8480
Entity
Organization
Contact information
Practice address
10814 72ND AVE, 4TH FLOOR, FOREST HILLS, NY 11375-5350
(718) 520-8480
Mailing address
239 OLD COUNTRY RD, DEER PARK, NY 11729-1927
(718) 520-8480
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
015236-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141864P
HIP
NY
01
—
6698072
GHI
NY
01
—
Q03D51
BCBS
NY
Enumeration date
04/12/2007
Last updated
08/22/2020
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