MEDICARE: DR. AYESHA HABIB DPT

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	038702	NY

General Provider Information

NPI Number	:	1861863060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYESHA HABIB DPT

Provider Business Mailing Address
First Line	:	313 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3712
Country	:	US
Telephone Number	:	585-455-1545
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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