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NPI Code Detail

MEDICARE: EL-MABOUSSOUT IGUE

MEDICARE: EL-MABOUSSOUT IGUE
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
1172A00000XDriver584806808NY

General Provider Information

NPI Number : 1689522526
Entity Type Code : Individual
Provider Name (Legal Business Name) : EL-MABOUSSOUT IGUE
Provider Business Mailing Address
First Line : 1433 E 104TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4515
Country : US
Telephone Number : 347-796-2577
Fax Number : 347-778-5933
Provider Business Practice Location Address
First Line : 473 BERGEN ST APT 1
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-4041
Country : US
Telephone Number : 347-796-2577
Fax Number : 347-796-5933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ EL-MABOUSSOUT IGUE ” Practice Location

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