Provider Demographics
NPI:1497364418
Name:ELSHALABY, IBRAHIM ALI (PT)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:ALI
Last Name:ELSHALABY
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 1:458 E 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4818
Mailing Address - Country:US
Mailing Address - Phone:929-366-1143
Mailing Address - Fax:
Practice Address - Street 1:458 E 7TH ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4818
Practice Address - Country:US
Practice Address - Phone:929-366-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist