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NPI Code Detail

MEDICARE: PYRAMIDS PT PLLC

MEDICARE: PYRAMIDS PT PLLC
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
1174400000XSpecialist030595NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073879235
Entity Type Code : Organization
Provider Name (Legal Business Name) : PYRAMIDS PT PLLC
Provider Business Mailing Address
First Line : 2752 OCEAN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-4706
Country : US
Telephone Number : 718-769-9001
Fax Number : 718-769-9002
Provider Business Practice Location Address
First Line : 2752 OCEAN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-4706
Country : US
Telephone Number : 718-769-9001
Fax Number : 718-769-9002
Authorized Official
Title or Position : PRESIDENT
Name : MR. MOHAMED M ELMANDOUH
Credential : PT
Telephone Number : 917-755-6680
Provider Enumeration Date : 04/02/2012
Last Update Date : 04/02/2012

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