Provider Demographics
NPI:1417159088
Name:ELSAIDY, MOHAMED YAHIA ABDALLA (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:YAHIA ABDALLA
Last Name:ELSAIDY
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 1:309 BEDFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:347-307-1509
Mailing Address - Fax:
Practice Address - Street 1:309 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5127
Practice Address - Country:US
Practice Address - Phone:347-307-1509
Practice Address - Fax:718-979-1470
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026231-1171W00000X
NY026231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor