Basic Information
| Provider Information | |||||||||
| NPI: | 1326243098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAWDROS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | FAWZI | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6860 AUSTIN ST STE 404 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474033241 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6860 AUSTIN ST STE 404 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182754700 | ||||||||
| FaxNumber: | 7182754744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 027797 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 027797 | 01 | NY | LICENSE NUMBER | OTHER |