Provider Demographics
NPI:1376768507
Name:ELIAS, SAMEH (RPT)
Entity Type:Individual
Prefix:
First Name:SAMEH
Middle Name:
Last Name:ELIAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 68TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5862
Mailing Address - Country:US
Mailing Address - Phone:917-609-4373
Mailing Address - Fax:
Practice Address - Street 1:9309 91ST AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2745
Practice Address - Country:US
Practice Address - Phone:917-609-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist