Provider Demographics
NPI:1679820138
Name:ELLAHI, MOHAMMAD F
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:F
Last Name:ELLAHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HEMLOCK DR
Mailing Address - Street 2:APT. 158
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2906
Mailing Address - Country:US
Mailing Address - Phone:631-665-1193
Mailing Address - Fax:
Practice Address - Street 1:1 HEMLOCK DR
Practice Address - Street 2:APT. 158
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2906
Practice Address - Country:US
Practice Address - Phone:631-665-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse