Provider Demographics
NPI:1104955624
Name:MOHAMED, MOHAMED A (BSC)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 CROPSEY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6604
Mailing Address - Country:US
Mailing Address - Phone:347-393-6565
Mailing Address - Fax:718-234-9203
Practice Address - Street 1:2546 CROPSEY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6604
Practice Address - Country:US
Practice Address - Phone:347-393-6565
Practice Address - Fax:718-234-9203
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist