Healthcare Provider Details

I. General information

NPI: 1912630104
Provider Name (Legal Business Name): MAHMOUD RATEB MOSA ABU ZAHRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-2330
  • Fax: 718-515-2608
Mailing address:
  • Phone: 718-515-2330
  • Fax: 718-515-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number337534
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number337534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: