Healthcare Provider Details

I. General information

NPI: 1467152207
Provider Name (Legal Business Name): MOUSTAFA HASSANIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 DITMARS BLVD
ASTORIA NY
11105-2717
US

IV. Provider business mailing address

102 MADISON AVE FL 8
NEW YORK NY
10016-7584
US

V. Phone/Fax

Practice location:
  • Phone: 646-307-1614
  • Fax: 855-955-3899
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: