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NPI Code Detail

MEDICARE: MAMDOUH SAYED IBRAHIM PTA

MEDICARE:   MAMDOUH SAYED IBRAHIM  PTA
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
1225200000XPhysical Therapy AssistantQB1281NJ

General Provider Information

NPI Number : 1437368669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAMDOUH SAYED IBRAHIM PTA
Provider Business Mailing Address
First Line : 33 SUNSET AVE
Second Line :
City : BAYONNE
State : NJ
Zip : 07002-2209
Country : US
Telephone Number : 201-339-5185
Fax Number :
Provider Business Practice Location Address
First Line : 221 COUNTY RD
Second Line :
City : CRESSKILL
State : NJ
Zip : 07626-1605
Country : US
Telephone Number : 201-567-9310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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Directions to “ MAMDOUH SAYED IBRAHIM PTA” Practice Location

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