Provider Demographics
NPI:1881256816
Name:IBRAHIM, KAWSAR (DPM)
Entity type:Individual
Prefix:DR
First Name:KAWSAR
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ABINGDON CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1345
Mailing Address - Country:US
Mailing Address - Phone:917-302-8342
Mailing Address - Fax:
Practice Address - Street 1:7401 4TH AVE APT A3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2542
Practice Address - Country:US
Practice Address - Phone:917-302-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007251213ES0131X
NJ25MD00369500213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery