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NPI Code Detail

MEDICARE: DR. MAHMOUD IBRAHIM IBRAHIM PHD, DSC,PTD, FACCWS

MEDICARE: DR. MAHMOUD IBRAHIM IBRAHIM PHD, DSC,PTD, FACCWS
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
1225100000XPhysical Therapist017978-1NY

General Provider Information

NPI Number : 1730119355
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAHMOUD IBRAHIM IBRAHIM PHD, DSC,PTD, FACCWS
Provider Business Mailing Address
First Line : 8415 10TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11228-3201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 380 88TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-5665
Country : US
Telephone Number : 718-748-5482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 03/19/2025

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