Provider Demographics
NPI:1649551607
Name:ELSAGGA, MOHAMED YOUSEF (DO)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:YOUSEF
Last Name:ELSAGGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAUREL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1403
Mailing Address - Country:US
Mailing Address - Phone:845-822-8100
Mailing Address - Fax:845-822-8110
Practice Address - Street 1:19 LAUREL AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1403
Practice Address - Country:US
Practice Address - Phone:845-822-8100
Practice Address - Fax:845-822-8110
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285958208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery