Provider Demographics
NPI:1295969921
Name:TAWADROS DAWOOD, SAMER FAHMY
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:FAHMY
Last Name:TAWADROS DAWOOD
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 1:12 MANDY CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1966
Mailing Address - Country:US
Mailing Address - Phone:917-589-0684
Mailing Address - Fax:
Practice Address - Street 1:8120 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3120
Practice Address - Country:US
Practice Address - Phone:917-589-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist