Provider Demographics
NPI:1205010527
Name:ELKOUSH IHAB TAHA PT PC
Entity Type:Organization
Organization Name:ELKOUSH IHAB TAHA PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:TAHA
Authorized Official - Last Name:ELKOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-756-8979
Mailing Address - Street 1:1473 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3001
Mailing Address - Country:US
Mailing Address - Phone:718-756-8979
Mailing Address - Fax:347-663-8881
Practice Address - Street 1:1473 STERLING PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213
Practice Address - Country:US
Practice Address - Phone:718-756-8979
Practice Address - Fax:347-663-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018307261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQM0371Medicare PIN