MEDICARE: MR. ATEF ISMAIL MOHAMED

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	0111471	NY

General Provider Information

NPI Number	:	1639445042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ATEF ISMAIL MOHAMED

Provider Business Mailing Address
First Line	:	2109 25TH RD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-3425
Country	:	US
Telephone Number	:	917-362-1130
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 25TH RD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-3425
Country	:	US
Telephone Number	:	917-362-1130
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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