Provider Demographics
NPI:1073879235
Name:PYRAMIDS PT PLLC
Entity Type:Organization
Organization Name:PYRAMIDS PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELMANDOUH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-755-6680
Mailing Address - Street 1:2752 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4706
Mailing Address - Country:US
Mailing Address - Phone:718-769-9001
Mailing Address - Fax:718-769-9002
Practice Address - Street 1:2752 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4706
Practice Address - Country:US
Practice Address - Phone:718-769-9001
Practice Address - Fax:718-769-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03420766Medicaid