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General NPI Number Information
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NPI Number | 1205010527
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Entity Type | Organization
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Legal Business Name | ELKOUSH IHAB TAHA PT PC
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 1473 STERLING PL
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City | BROOKLYN
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State | NY
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Zip | 11213
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Country | US
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Telephone | 718-756-8979
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Fax | 347-663-8881
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Provider Business Mailing Address
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Address Line | 1473 STERLING PL
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City | BROOKLYN
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State | NY
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Zip | 11213-3001
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Country | US
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Telephone | 718-756-8979
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Fax | 347-663-8881
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Authorized Official
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Title or Position | OWNER
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Name | DR. IHAB TAHA ELKOUSH
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Credential | D.P.T
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Telephone | 718-756-8979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 018307
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License Number State | NY
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