Provider Demographics
NPI:1699807610
Name:HUSSEIN, MOWAFAK FAWZY SAID
Entity Type:Individual
Prefix:
First Name:MOWAFAK
Middle Name:FAWZY SAID
Last Name:HUSSEIN
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 1:2006 65TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3900
Mailing Address - Country:US
Mailing Address - Phone:718-795-3666
Mailing Address - Fax:347-312-5090
Practice Address - Street 1:2006 65TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3900
Practice Address - Country:US
Practice Address - Phone:718-795-3666
Practice Address - Fax:347-312-5090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist