Provider Demographics
NPI:1801513809
Name:HOSSAM ADHAM
Entity type:Organization
Organization Name:HOSSAM ADHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-885-5620
Mailing Address - Street 1:2165 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5035
Mailing Address - Country:US
Mailing Address - Phone:718-885-5620
Mailing Address - Fax:
Practice Address - Street 1:1942 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4704
Practice Address - Country:US
Practice Address - Phone:718-885-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty