MEDICARE: AHMED SAMIR ELOKDA PT, PHD

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	014763-1	NY

General Provider Information

NPI Number	:	1588874747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMED SAMIR ELOKDA PT, PHD

Provider Business Mailing Address
First Line	:	2518 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3916
Country	:	US
Telephone Number	:	718-934-5395
Fax Number	:	718-616-0921

Provider Business Practice Location Address
First Line	:	2518 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3916
Country	:	US
Telephone Number	:	718-934-5395
Fax Number	:	718-616-0921

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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