Healthcare Provider Details

I. General information

NPI: 1467029496
Provider Name (Legal Business Name): MUHAMMAD ELSAYED GHALLAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-68 164TH STREET, N BUILDING, 7TH FL, RM N-705
JAMAICA NY
11432
US

IV. Provider business mailing address

7840 164TH ST APT 6D
FRESH MEADOWS NY
11366
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3000
  • Fax: 718-883-6197
Mailing address:
  • Phone: 929-582-9048
  • Fax: 718-883-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: