Provider Demographics
NPI:1326172297
Name:KRAISH, MOHAMMED (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:KRAISH
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 1:1254 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4916
Mailing Address - Country:US
Mailing Address - Phone:917-776-1929
Mailing Address - Fax:
Practice Address - Street 1:575 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6102
Practice Address - Country:US
Practice Address - Phone:212-371-7869
Practice Address - Fax:212-755-2030
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist