Provider Demographics
NPI:1326675778
Name:ELZALATA, MOHAMED FAKRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:FAKRY
Last Name:ELZALATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6927 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1304
Mailing Address - Country:US
Mailing Address - Phone:347-947-7790
Mailing Address - Fax:
Practice Address - Street 1:6927 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1304
Practice Address - Country:US
Practice Address - Phone:347-947-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics