MEDICARE: MOUNZER TCHELEBI 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	2085R0001X	Radiation Oncology Physician	1609011	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1639152960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUNZER TCHELEBI MD

Provider Business Mailing Address
First Line	:	374 STOCKHOLM STREET
Second Line	:	SUITE C 08
City	:	BROOKLYN
State	:	NY
Zip	:	11237
Country	:	US
Telephone Number	:	718-963-7381
Fax Number	:	718-963-7744

Provider Business Practice Location Address
First Line	:	374 STOCKHOLM ST
Second Line	:	SUITE C 08
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4006
Country	:	US
Telephone Number	:	718-963-7381
Fax Number	:	718-963-7744

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	11/19/2011

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