Provider Demographics
NPI:1467068510
Name:AHMED, HESHAM AHMED ALI (PT)
Entity Type:Individual
Prefix:DR
First Name:HESHAM
Middle Name:AHMED ALI
Last Name:AHMED
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 1:2355 38TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1909
Mailing Address - Country:US
Mailing Address - Phone:929-418-9981
Mailing Address - Fax:
Practice Address - Street 1:10814 72ND AVE STE 4
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5301
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist