MEDICARE: DR. MOHAMED FAKRY ELZALATA MD

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	208000000X	Pediatrics Physician	323936	NY

General Provider Information

NPI Number	:	1326675778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED FAKRY ELZALATA MD

Provider Business Mailing Address
First Line	:	6927 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1304
Country	:	US
Telephone Number	:	347-947-7790
Fax Number	:

Provider Business Practice Location Address
First Line	:	6927 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1304
Country	:	US
Telephone Number	:	347-947-7790
Fax Number	:

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	06/26/2023

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