Provider Demographics
NPI:1902204415
Name:MOUSA, AHMED HANAFY
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:HANAFY
Last Name:MOUSA
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 1:565 85TH ST
Mailing Address - Street 2:APT B27
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4863
Mailing Address - Country:US
Mailing Address - Phone:718-415-5968
Mailing Address - Fax:
Practice Address - Street 1:6919 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1501
Practice Address - Country:US
Practice Address - Phone:718-745-2020
Practice Address - Fax:718-745-2022
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist