Provider Demographics
NPI:1790501690
Name:AWAD, ISMAIL MOHAMED MOHAMED (PT)
Entity type:Individual
Prefix:
First Name:ISMAIL
Middle Name:MOHAMED MOHAMED
Last Name:AWAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3160
Mailing Address - Country:US
Mailing Address - Phone:929-919-6844
Mailing Address - Fax:929-502-7744
Practice Address - Street 1:8031 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3160
Practice Address - Country:US
Practice Address - Phone:929-919-6844
Practice Address - Fax:929-502-7744
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist