Provider Demographics
NPI:1710338082
Name:RAMADAN, ABOALYAZID (DPT)
Entity Type:Individual
Prefix:
First Name:ABOALYAZID
Middle Name:
Last Name:RAMADAN
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 1:6536 99TH ST APT 5R
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4307
Mailing Address - Country:US
Mailing Address - Phone:929-421-6634
Mailing Address - Fax:
Practice Address - Street 1:6536 99TH ST APT 5R
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4307
Practice Address - Country:US
Practice Address - Phone:929-421-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist