Provider Demographics
NPI:1699014795
Name:ABD ELRAHMAN, MOHAMED MOKHTAR (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:MOKHTAR
Last Name:ABD ELRAHMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5934
Mailing Address - Country:US
Mailing Address - Phone:718-645-2335
Mailing Address - Fax:718-645-3404
Practice Address - Street 1:282 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5934
Practice Address - Country:US
Practice Address - Phone:718-645-2335
Practice Address - Fax:718-645-3404
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033702-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033702-1OtherLICENSE