Provider Demographics
NPI:1265838049
Name:ABDELLATIF, MOHAMED S (DPT)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:S
Last Name:ABDELLATIF
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 1:2219 64TH ST APT E6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3223
Mailing Address - Country:US
Mailing Address - Phone:929-245-0980
Mailing Address - Fax:
Practice Address - Street 1:2219 64TH ST APT E6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3223
Practice Address - Country:US
Practice Address - Phone:929-245-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist