Provider Demographics
NPI:1194747097
Name:ELKOUSH, IHAB TAHA (DPT)
Entity type:Individual
Prefix:DR
First Name:IHAB
Middle Name:TAHA
Last Name:ELKOUSH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3001
Mailing Address - Country:US
Mailing Address - Phone:718-756-8979
Mailing Address - Fax:718-756-8979
Practice Address - Street 1:1473 STERLING PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213
Practice Address - Country:US
Practice Address - Phone:718-756-8979
Practice Address - Fax:347-663-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0205336Medicaid
NY0205336Medicaid