Basic Information
| Provider Information | |||||||||
| NPI: | 1104088699 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL DIMENTION THERAPY LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2421 AVENUE U | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112294905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186161966 | ||||||||
| FaxNumber: | 7183825252 | ||||||||
| Practice Location | |||||||||
| Address1: | 2421 AVENUE U | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112294905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186161966 | ||||||||
| FaxNumber: | 7183825252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | DARDEIR | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7186161966 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 022859 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.