Provider Demographics
NPI:1336479187
Name:ELKHOLY, HOSSAMELDIEN
Entity Type:Individual
Prefix:
First Name:HOSSAMELDIEN
Middle Name:
Last Name:ELKHOLY
Suffix:
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 1:1922 63RD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3051
Mailing Address - Country:US
Mailing Address - Phone:347-374-3786
Mailing Address - Fax:
Practice Address - Street 1:1922 63RD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3051
Practice Address - Country:US
Practice Address - Phone:347-374-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist