Healthcare Provider Details

I. General information

NPI: 1063336121
Provider Name (Legal Business Name): CORNWELL PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 CORNWELL AVE
MALVERNE NY
11565-1347
US

IV. Provider business mailing address

543 CORNWELL AVE
MALVERNE NY
11565-1347
US

V. Phone/Fax

Practice location:
  • Phone: 347-687-3966
  • Fax: 929-999-5706
Mailing address:
  • Phone: 347-687-3966
  • Fax: 929-999-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHMOUD ELSAYED DAWOOD DAIF
Title or Position: OWNER
Credential: DPT
Phone: 347-902-4699