Provider Demographics
NPI:1548497530
Name:GOMAA, GAMAL ABDEL FATTAH (DPT)
Entity type:Individual
Prefix:DR
First Name:GAMAL
Middle Name:ABDEL FATTAH
Last Name:GOMAA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:249 95TH ST
Mailing Address - Street 2:APT # 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6828
Mailing Address - Country:US
Mailing Address - Phone:917-450-6545
Mailing Address - Fax:718-921-7374
Practice Address - Street 1:249 95TH ST
Practice Address - Street 2:APT # 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6828
Practice Address - Country:US
Practice Address - Phone:917-450-6545
Practice Address - Fax:718-921-7374
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010907147OtherEIN