Provider Demographics
NPI:1003369505
Name:MOSTAFA, AMR H
Entity Type:Individual
Prefix:
First Name:AMR
Middle Name:H
Last Name:MOSTAFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 SHORE PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1717
Mailing Address - Country:US
Mailing Address - Phone:347-666-7816
Mailing Address - Fax:
Practice Address - Street 1:353 OCEAN AVE
Practice Address - Street 2:APT PROF1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1326
Practice Address - Country:US
Practice Address - Phone:718-940-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039402-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist