Provider Demographics
NPI:1255516456
Name:MOUSTAFA, MOHAMED A (DOCTOR OF PHYSICAL T)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:MOUSTAFA
Suffix:
Gender:M
Credentials:DOCTOR OF PHYSICAL T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 4TH AVE
Mailing Address - Street 2:5G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4655
Mailing Address - Country:US
Mailing Address - Phone:718-833-7819
Mailing Address - Fax:
Practice Address - Street 1:8500 4TH AVE
Practice Address - Street 2:5G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4655
Practice Address - Country:US
Practice Address - Phone:718-833-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17872Medicaid