Provider Demographics
NPI:1376557538
Name:MOHAMMED, HUSSEIN AMEEN (PT)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:AMEEN
Last Name:MOHAMMED
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 1:1070 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2304
Mailing Address - Country:US
Mailing Address - Phone:718-439-1057
Mailing Address - Fax:718-439-0158
Practice Address - Street 1:1070 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2304
Practice Address - Country:US
Practice Address - Phone:718-439-1057
Practice Address - Fax:718-439-0158
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14T11Medicare ID - Type Unspecified
NYW39641Medicare UPIN