MEDICARE: SPHINX I PT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1093056871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPHINX I PT PC

Provider Business Mailing Address
First Line	:	1924 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2345
Country	:	US
Telephone Number	:	347-607-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2345
Country	:	US
Telephone Number	:	347-607-0555
Fax Number	:

Authorized Official
Title or Position	:	DR
Name	:	DR. MOHAMED AMAL ELAZHARY
Credential	:	PHDPT
Telephone Number	:	347-607-0555

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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