Provider Demographics
NPI:1124801360
Name:ISLAM, MOHAMMED A (PT, DPT)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:ISLAM
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2863
Mailing Address - Country:US
Mailing Address - Phone:347-407-4119
Mailing Address - Fax:
Practice Address - Street 1:2255 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5126
Practice Address - Country:US
Practice Address - Phone:718-434-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist