Provider Demographics
NPI:1023258431
Name:HOMESIDE REHAB, PT, OT, SLP LLC
Entity type:Organization
Organization Name:HOMESIDE REHAB, PT, OT, SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YISROEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-754-6634
Mailing Address - Street 1:296 ROUTE 59 STE 12-25
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5322
Mailing Address - Country:US
Mailing Address - Phone:718-377-5000
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:441 ROUTE 306 STE 2
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1234
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:718-377-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016301261QX0100X
NY016813235Z00000X
NY030125261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001261Medicare PIN