Healthcare Provider Details

I. General information

NPI: 1669306221
Provider Name (Legal Business Name): MOHAMED AHMED HABIB PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 BROADWAY
ELMHURST NY
11373-3160
US

IV. Provider business mailing address

8031 BROADWAY
ELMHURST NY
11373-3160
US

V. Phone/Fax

Practice location:
  • Phone: 929-919-6844
  • Fax: 929-502-7744
Mailing address:
  • Phone: 929-919-6844
  • Fax: 929-502-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: