| Organization Name: | ST TEREIZA OFF OF PHY TER PC |
| NPI Number: | 1568657575 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MALAK ISHAK AZAB (DOCTOR OF PHYSICAL THERAPY) |
| Mailing Address: | 2539 Middle Country Rd Ste 101 Centereach |
| State: | NY US |
| Postal Code: | 117203551 |
| Phone Number: | 6314673381 |
| Fax Number: | 6314673383 |
| NPI Enumeration Date: | 09/12/2007 |
| NPI Last Update Date: | 07/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 021295 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |