MEDICARE: SAHAR NOURELDIN PT

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	035542-1	NY

General Provider Information

NPI Number	:	1659712024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAHAR NOURELDIN PT

Provider Business Mailing Address
First Line	:	136 OSWEGO ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 74TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-5603
Country	:	US
Telephone Number	:	718-280-1137
Fax Number	:

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/12/2013

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