Healthcare Provider Details

I. General information

NPI: 1528908738
Provider Name (Legal Business Name): MAHMOUD ELSAYED PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 RALPH AVE
BROOKLYN NY
11234-5405
US

IV. Provider business mailing address

2681 W 2ND ST
BROOKLYN NY
11223-6377
US

V. Phone/Fax

Practice location:
  • Phone: 718-451-1400
  • Fax: 718-451-2797
Mailing address:
  • Phone: 929-461-8479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: