Provider Demographics
NPI:1407923378
Name:MOHAMED, SALAHELDIN (PT)
Entity Type:Individual
Prefix:
First Name:SALAHELDIN
Middle Name:
Last Name:MOHAMED
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 1:2848 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4106
Mailing Address - Country:US
Mailing Address - Phone:718-941-2200
Mailing Address - Fax:718-703-0872
Practice Address - Street 1:2848 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4106
Practice Address - Country:US
Practice Address - Phone:718-941-2200
Practice Address - Fax:718-703-0872
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012734-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01743113Medicaid
NY01743113Medicaid