Provider Demographics
NPI:1639152960
Name:TCHELEBI, MOUNZER (MD)
Entity Type:Individual
Prefix:
First Name:MOUNZER
Middle Name:
Last Name:TCHELEBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 STOCKHOLM STREET
Mailing Address - Street 2:SUITE C 08
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237
Mailing Address - Country:US
Mailing Address - Phone:718-963-7381
Mailing Address - Fax:718-963-7744
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:SUITE C 08
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7381
Practice Address - Fax:718-963-7744
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16090112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00980974Medicaid
NY67D851Medicare ID - Type Unspecified
NY00980974Medicaid