Healthcare Provider Details

I. General information

NPI: 1699014795
Provider Name (Legal Business Name): MOHAMED MOKHTAR ABD ELRAHMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 AVENUE X
BROOKLYN NY
11223-5934
US

IV. Provider business mailing address

282 AVENUE X
BROOKLYN NY
11223-5934
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-2335
  • Fax: 718-645-3404
Mailing address:
  • Phone: 718-645-2335
  • Fax: 718-645-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033702-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier033702-1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: