MEDICARE: DR. MOHAMED HAMED ZIDAN DPT

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	022330-1	NY

General Provider Information

NPI Number	:	1114102696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED HAMED ZIDAN DPT

Provider Business Mailing Address
First Line	:	2546 CROPSEY AVE
Second Line	:	1 ST. FL.
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6604
Country	:	US
Telephone Number	:	917-622-6058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2546 CROPSEY AVE
Second Line	:	1 ST. FL.
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6604
Country	:	US
Telephone Number	:	718-946-6058
Fax Number	:

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	10/22/2008

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