Provider Demographics
NPI:1528019197
Name:MOUSTAFA, BAYOMY (PT)
Entity Type:Individual
Prefix:DR
First Name:BAYOMY
Middle Name:
Last Name:MOUSTAFA
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 1:438 100TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8309
Mailing Address - Country:US
Mailing Address - Phone:917-886-7569
Mailing Address - Fax:718-940-9012
Practice Address - Street 1:810 ROGERS AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3640
Practice Address - Country:US
Practice Address - Phone:718-940-9010
Practice Address - Fax:718-940-9012
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist