Provider Demographics
NPI:1104950393
Name:ABULMAGD, ABDELRAHIM A
Entity type:Individual
Prefix:
First Name:ABDELRAHIM
Middle Name:A
Last Name:ABULMAGD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BELAIR LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3067
Mailing Address - Country:US
Mailing Address - Phone:718-812-6764
Mailing Address - Fax:718-448-3979
Practice Address - Street 1:58 BELAIR LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3067
Practice Address - Country:US
Practice Address - Phone:718-812-6764
Practice Address - Fax:718-448-3979
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist