Provider Demographics
NPI:1821210717
Name:SHAABAN, EZZAT MOHAMED (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:EZZAT
Middle Name:MOHAMED
Last Name:SHAABAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8402 4TH AVE.
Mailing Address - Street 2:APT# C8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-921-0792
Mailing Address - Fax:718-921-0792
Practice Address - Street 1:8402 4TH AVE.
Practice Address - Street 2:APT# C8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-921-0792
Practice Address - Fax:718-921-0792
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist