Provider Demographics
NPI:1396924981
Name:ELEESILY, KHALED HOUSSEIN (PT,DPT)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:HOUSSEIN
Last Name:ELEESILY
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3744
Mailing Address - Country:US
Mailing Address - Phone:718-926-3344
Mailing Address - Fax:
Practice Address - Street 1:578 FORT HILL PL
Practice Address - Street 2:3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3608
Practice Address - Country:US
Practice Address - Phone:718-926-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014768-012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic