Provider Demographics
NPI:1609396977
Name:RIZK, ADAM MUSTAFA (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MUSTAFA
Last Name:RIZK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MAHMOUD
Other - Middle Name:MUSTAFA
Other - Last Name:RIZK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 28TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7064
Mailing Address - Country:US
Mailing Address - Phone:407-848-9693
Mailing Address - Fax:
Practice Address - Street 1:1611 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6860
Practice Address - Country:US
Practice Address - Phone:718-566-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty