MEDICARE: MOHAMED FAROUK-ELSOMANY AHMED DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	021340	NY

General Provider Information

NPI Number	:	1023263795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED FAROUK-ELSOMANY AHMED DPT

Provider Business Mailing Address
First Line	:	2032 W 5TH ST
Second Line	:	FIRST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3835
Country	:	US
Telephone Number	:	917-957-2511
Fax Number	:	718-946-1776

Provider Business Practice Location Address
First Line	:	2032 W 5TH ST
Second Line	:	FIRST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3835
Country	:	US
Telephone Number	:	917-957-2511
Fax Number	:	718-946-1776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2008
Last Update Date	:	11/23/2008

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