Provider Demographics
NPI:1114102696
Name:ZIDAN, MOHAMED HAMED (DPT)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:HAMED
Last Name:ZIDAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 CROPSEY AVE
Mailing Address - Street 2:1 ST. FL.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6604
Mailing Address - Country:US
Mailing Address - Phone:917-622-6058
Mailing Address - Fax:
Practice Address - Street 1:2546 CROPSEY AVE
Practice Address - Street 2:1 ST. FL.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6604
Practice Address - Country:US
Practice Address - Phone:718-946-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022330-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP96033Medicare UPIN