Healthcare Provider Details

I. General information

NPI: 1790437937
Provider Name (Legal Business Name): MOHAMED OWIEDA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 10/26/2023
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 5TH AVENUE, FLOOR 2
NEW YORK NY
10011
US

IV. Provider business mailing address

1764 E 19TH STREET
BROOKLYN NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 212-287-4257
  • Fax: 855-955-3899
Mailing address:
  • Phone: 347-465-5675
  • Fax: 855-955-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number047302-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: