MEDICARE: MOHAMED A MOHAMED BSC

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	174400000X	Specialist	027281	NY

General Provider Information

NPI Number	:	1104955624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED A MOHAMED BSC

Provider Business Mailing Address
First Line	:	2546 CROPSEY AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6604
Country	:	US
Telephone Number	:	347-393-6565
Fax Number	:	718-234-9203

Provider Business Practice Location Address
First Line	:	2546 CROPSEY AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6604
Country	:	US
Telephone Number	:	347-393-6565
Fax Number	:	718-234-9203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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