MEDICARE: EGLAL YEHIA GAMALELDEIN ALI

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	036269	NY

General Provider Information

NPI Number	:	1922646629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EGLAL YEHIA GAMALELDEIN ALI

Provider Business Mailing Address
First Line	:	1732 STANHOPE ST
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-1451
Country	:	US
Telephone Number	:	347-325-0119
Fax Number	:

Provider Business Practice Location Address
First Line	:	8746 20TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4802
Country	:	US
Telephone Number	:	718-238-7451
Fax Number	:

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

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	12/13/2019

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