Healthcare Provider Details

I. General information

NPI: 1255243531
Provider Name (Legal Business Name): AHMED ELGAMAL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2069 BAY RIDGE PKWY
BROOKLYN NY
11204-5934
US

IV. Provider business mailing address

2069 BAY RIDGE PKWY
BROOKLYN NY
11204-5934
US

V. Phone/Fax

Practice location:
  • Phone: 929-382-1683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: