Provider Demographics
NPI:1477833598
Name:ELKHATIB, HASSAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:ELKHATIB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:KIAMESHA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12751-0130
Mailing Address - Country:US
Mailing Address - Phone:845-796-2470
Mailing Address - Fax:845-796-1420
Practice Address - Street 1:1734 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4824
Practice Address - Country:US
Practice Address - Phone:917-645-5388
Practice Address - Fax:917-645-5391
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist