Provider Demographics
NPI:1407094659
Name:MOHAMMED EL, PATRESE
Entity Type:Individual
Prefix:
First Name:PATRESE
Middle Name:
Last Name:MOHAMMED EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6207
Mailing Address - Country:US
Mailing Address - Phone:631-669-5355
Mailing Address - Fax:
Practice Address - Street 1:11 ROUTE 109
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6207
Practice Address - Country:US
Practice Address - Phone:916-308-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299954164X00000X, 164W00000X
CAVN164933164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse