Provider Demographics
NPI:1104087428
Name:KHAMISE, AHMED (DPT)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:KHAMISE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 RIDGE BLVD
Mailing Address - Street 2:2K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6754
Mailing Address - Country:US
Mailing Address - Phone:718-614-5700
Mailing Address - Fax:
Practice Address - Street 1:77 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6718
Practice Address - Country:US
Practice Address - Phone:718-614-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015901OtherLICENSE