Provider Demographics
NPI:1659405272
Name:ELKALEA, MOHAMED (PT)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:ELKALEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:MOHAMED
Other - Middle Name:
Other - Last Name:ELKALEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2327 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3654
Mailing Address - Country:US
Mailing Address - Phone:718-721-2787
Mailing Address - Fax:718-721-5995
Practice Address - Street 1:418 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3206
Practice Address - Country:US
Practice Address - Phone:718-745-5550
Practice Address - Fax:718-745-5551
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08291Medicare PIN