Healthcare Provider Details

I. General information

NPI: 1104876408
Provider Name (Legal Business Name): MAMDOUH M ELDEEB PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESTCHESTER AVE SUITE LL5
BRONX NY
10461-4500
US

IV. Provider business mailing address

18 FAITH LN
ARDSLEY NY
10502-2529
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-8040
  • Fax: 718-518-8043
Mailing address:
  • Phone: 914-484-8210
  • Fax: 718-518-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number011463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: