Provider Demographics
NPI:1912375163
Name:GHANEM, AHMED MOHAMED MAHMOUD (PT)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:MOHAMED MAHMOUD
Last Name:GHANEM
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 1:535 FIFTH AVENUE
Mailing Address - Street 2:SUITE 906
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-973-8299
Mailing Address - Fax:212-937-3304
Practice Address - Street 1:535 FIFTH AVENUE
Practice Address - Street 2:SUITE 906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-973-8299
Practice Address - Fax:212-937-3304
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2017-04-20
Deactivation Date:2016-04-11
Deactivation Code:
Reactivation Date:2017-04-20
Provider Licenses
StateLicense IDTaxonomies
NY038313-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist