MEDICARE: DR. BAYOMY MOUSTAFA PT

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	014472	NY

General Provider Information

NPI Number	:	1528019197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAYOMY MOUSTAFA PT

Provider Business Mailing Address
First Line	:	438 100TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-8309
Country	:	US
Telephone Number	:	917-886-7569
Fax Number	:	718-940-9012

Provider Business Practice Location Address
First Line	:	810 ROGERS AVE
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3640
Country	:	US
Telephone Number	:	718-940-9010
Fax Number	:	718-940-9012

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/10/2015

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