Healthcare Provider Details

I. General information

NPI: 1548140379
Provider Name (Legal Business Name): MAHMOUD W ELZAYAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 RICHMOND HILL RD
STATEN ISLAND NY
10314-5904
US

IV. Provider business mailing address

10 THRUSH MEWS
NORTH BRUNSWICK NJ
08902-1223
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-5678
  • Fax:
Mailing address:
  • Phone: 347-682-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09258100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: