Healthcare Provider Details

I. General information

NPI: 1407685621
Provider Name (Legal Business Name): MAZEN MOHAMED IBRAHIM IBRAHIM MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 30
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE # 30
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2045
  • Fax:
Mailing address:
  • Phone: 718-270-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number341446
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0074162
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number341446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: