Provider Demographics
NPI:1073701025
Name:ABOUELELA, MOUSTAFA (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:MOUSTAFA
Middle Name:
Last Name:ABOUELELA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6188 DRY HARBOR RD
Mailing Address - Street 2:5E
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1535
Mailing Address - Country:US
Mailing Address - Phone:646-724-4459
Mailing Address - Fax:718-424-5070
Practice Address - Street 1:6188 DRY HARBOR RD
Practice Address - Street 2:5E
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1535
Practice Address - Country:US
Practice Address - Phone:646-724-4459
Practice Address - Fax:718-424-5070
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY027999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist