Healthcare Provider Details

I. General information

NPI: 1639152960
Provider Name (Legal Business Name): MOUNZER TCHELEBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST SUITE C 08
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

374 STOCKHOLM STREET SUITE C 08
BROOKLYN NY
11237
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7381
  • Fax: 718-963-7744
Mailing address:
  • Phone: 718-963-7381
  • Fax: 718-963-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number1609011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: