Provider Demographics
NPI:1700226297
Name:ELSHAZLY, NADIM M (DPT)
Entity Type:Individual
Prefix:DR
First Name:NADIM
Middle Name:M
Last Name:ELSHAZLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 82ND ST # 1G1F
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2939
Mailing Address - Country:US
Mailing Address - Phone:718-540-4740
Mailing Address - Fax:718-732-2378
Practice Address - Street 1:3457 82ND ST # 1G1F
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2939
Practice Address - Country:US
Practice Address - Phone:718-540-4740
Practice Address - Fax:718-732-2378
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4377235Medicaid
NY03783427OtherEMPIRE BLUE CROSS BLUE SHIELD
1173331OtherWELLCARE MEDICARE & MEDICAID (ALL PRODUCTS)
NY180926000173OtherFIDELIS CARE (ALL PRODUCTS, INCLUDING EXCHANGE)
NYP0072003OtherELDERPLAN