Provider Demographics
NPI:1538729272
Name:MOHAMED, MAHMOUD DIAB (DPT, PHD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:DIAB
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 101ST ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1709
Mailing Address - Country:US
Mailing Address - Phone:929-575-2488
Mailing Address - Fax:
Practice Address - Street 1:6860 AUSTIN ST STE 307
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4223
Practice Address - Country:US
Practice Address - Phone:929-575-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY413641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist