Provider Demographics
NPI:1154622066
Name:HUSSIEN, AMR MOHAMED MOSTAFA
Entity type:Individual
Prefix:
First Name:AMR
Middle Name:MOHAMED MOSTAFA
Last Name:HUSSIEN
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 1:67-38B 190TH LANE
Mailing Address - Street 2:APT# #B
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3414
Mailing Address - Country:US
Mailing Address - Phone:347-839-8814
Mailing Address - Fax:
Practice Address - Street 1:451 78TH STREET, APT#6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3414
Practice Address - Country:US
Practice Address - Phone:347-839-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist