Provider Demographics
NPI:1932693546
Name:ABOZEID, KHALED MOSTAFA (KHALED)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:MOSTAFA
Last Name:ABOZEID
Suffix:
Gender:M
Credentials:KHALED
Other - Prefix:
Other - First Name:KHALED
Other - Middle Name:ISMAIL
Other - Last Name:ABOZEID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3-15 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3844
Mailing Address - Country:US
Mailing Address - Phone:917-607-6046
Mailing Address - Fax:
Practice Address - Street 1:3795 E TREMONT AVE STE 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2457
Practice Address - Country:US
Practice Address - Phone:332-216-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist