=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700226297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADIM M ELSHAZLY DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2013
-----------------------------------------------------
Last Update Date | 12/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3457 82ND ST # 1G1F
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-540-4740
-----------------------------------------------------
Fax | 718-732-2378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3457 82ND ST # 1G1F
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-540-4740
-----------------------------------------------------
Fax | 718-732-2378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 034824
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------