Provider Demographics
NPI:1396948675
Name:MAHMOUD, AHMED FEKRY (PT)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:FEKRY
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:AHMED
Other - Middle Name:F
Other - Last Name:MAHMOUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 940068
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-0068
Mailing Address - Country:US
Mailing Address - Phone:718-945-7878
Mailing Address - Fax:718-945-7879
Practice Address - Street 1:11412 BEACH CHANNEL DR
Practice Address - Street 2:SUITE6
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2215
Practice Address - Country:US
Practice Address - Phone:718-945-7878
Practice Address - Fax:718-945-7879
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638580Medicaid
NY02638580Medicaid
NY07361HMedicare ID - Type UnspecifiedGHI MEDICARE