Provider Demographics
NPI:1700486362
Name:DAROUICH, HAMDI (DPT, MS)
Entity Type:Individual
Prefix:
First Name:HAMDI
Middle Name:
Last Name:DAROUICH
Suffix:
Gender:M
Credentials:DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2640
Mailing Address - Country:US
Mailing Address - Phone:347-388-4424
Mailing Address - Fax:
Practice Address - Street 1:180 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2640
Practice Address - Country:US
Practice Address - Phone:347-388-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046366-01225100000X
NY046366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist