Provider Demographics
NPI:1205192002
Name:ELNAGGAR, FATHI ABDELWAHAB (PT)
Entity Type:Individual
Prefix:MR
First Name:FATHI
Middle Name:ABDELWAHAB
Last Name:ELNAGGAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4729
Mailing Address - Country:US
Mailing Address - Phone:347-606-3917
Mailing Address - Fax:347-606-3917
Practice Address - Street 1:127 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4729
Practice Address - Country:US
Practice Address - Phone:347-606-3917
Practice Address - Fax:347-606-3917
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist