Provider Demographics
NPI:1104876408
Name:ELDEEB, MAMDOUH M (PT)
Entity type:Individual
Prefix:
First Name:MAMDOUH
Middle Name:M
Last Name:ELDEEB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FAITH LN
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2529
Mailing Address - Country:US
Mailing Address - Phone:914-484-8210
Mailing Address - Fax:718-518-8043
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:SUITE LL5
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-518-8040
Practice Address - Fax:718-518-8043
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011463174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist