MEDICARE: LEILA NAHMOUD

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	225200000X	Physical Therapy Assistant	014010	NY

General Provider Information

NPI Number	:	1932974474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA NAHMOUD

Provider Business Mailing Address
First Line	:	2318 WEST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5229
Country	:	US
Telephone Number	:	347-837-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 MAIDEN LN RM 404
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4636
Country	:	US
Telephone Number	:	917-455-4881
Fax Number	:

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

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	11/15/2023

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Directions to “ LEILA NAHMOUD ” Practice Location

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