Provider Demographics
NPI:1346418456
Name:HAIKEL, AHMED MOHAMED (PT)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:MOHAMED
Last Name:HAIKEL
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 1:6 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4029
Mailing Address - Country:US
Mailing Address - Phone:917-361-5863
Mailing Address - Fax:718-979-0922
Practice Address - Street 1:6 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4029
Practice Address - Country:US
Practice Address - Phone:917-361-5863
Practice Address - Fax:718-979-0922
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022676-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ16A01Medicare Oscar/Certification