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General NPI Number Information
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NPI Number | 1366779787
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL FOR SPORT & REHABILITATION, P.C.
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 3857 KINGS HWY STE 1-I
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 718-258-7203
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Fax | 718-258-7202
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Provider Business Mailing Address
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Address Line | PO BOX 290707
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City | BROOKLYN
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State | NY
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Zip | 11229-0707
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Country | US
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Telephone | 718-258-7203
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Fax | 718-258-7202
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Authorized Official
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Title or Position | OWNER
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Name | DR. AHMED E. ELEMAM
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Credential | M.D.
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Telephone | 718-258-7203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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