Healthcare Provider Details

I. General information

NPI: 1073254488
Provider Name (Legal Business Name): MOHAMED NASERELDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

510 N BROAD ST APT 738
PHILADELPHIA PA
19130-4348
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-2205
  • Fax:
Mailing address:
  • Phone: 608-630-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD490669
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301517156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: