Healthcare Provider Details

I. General information

NPI: 1316711211
Provider Name (Legal Business Name): ESLAM MOHAMED MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 E 12TH ST # M1
BROOKLYN NY
11230-3667
US

IV. Provider business mailing address

983 E 12TH ST # M1
BROOKLYN NY
11230-3667
US

V. Phone/Fax

Practice location:
  • Phone: 347-988-1145
  • Fax:
Mailing address:
  • Phone: 347-988-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHINUR FIRDAVSI
Title or Position: MANAGING EMPLOYEE
Credential: PA
Phone: 347-988-1145