Provider Demographics
NPI:1588809677
Name:OMAR, HOSSAM ELDIN MONIR (DPT)
Entity Type:Individual
Prefix:
First Name:HOSSAM ELDIN
Middle Name:MONIR
Last Name:OMAR
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 1:24 FRANCESCA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2101
Mailing Address - Country:US
Mailing Address - Phone:718-698-1391
Mailing Address - Fax:718-698-1391
Practice Address - Street 1:24 FRANCESCA LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2101
Practice Address - Country:US
Practice Address - Phone:718-698-1391
Practice Address - Fax:718-698-1391
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI007772225100000X
NY014788-1225100000X
IN05003843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist