Provider Demographics
NPI:1255657276
Name:ABBAS, HOSSAM SIEFALLAH SR
Entity Type:Individual
Prefix:MR
First Name:HOSSAM
Middle Name:SIEFALLAH
Last Name:ABBAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2234
Mailing Address - Country:US
Mailing Address - Phone:718-450-7070
Mailing Address - Fax:718-621-0777
Practice Address - Street 1:4730 59TH ST
Practice Address - Street 2:APT. 4A
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5547
Practice Address - Country:US
Practice Address - Phone:347-822-9557
Practice Address - Fax:347-848-0640
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015774-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist