Healthcare Provider Details

I. General information

NPI: 1215843636
Provider Name (Legal Business Name): MEHRAN MOHAMMAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 5TH AVE STE 1
BROOKLYN NY
11215-7373
US

IV. Provider business mailing address

3319 AVENUE N STE 1
BROOKLYN NY
11234-2605
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: