Healthcare Provider Details

I. General information

NPI: 1215861372
Provider Name (Legal Business Name): HOSSAM ELBENAWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 45TH ST
BROOKLYN NY
11219
US

IV. Provider business mailing address

1042 45TH ST
BROOKLYN NY
11219-1962
US

V. Phone/Fax

Practice location:
  • Phone: 507-271-5263
  • Fax:
Mailing address:
  • Phone: 507-271-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50739
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: