Provider Demographics
NPI:1316711211
Name:ESLAM MOHAMED MEDICAL PLLC
Entity type:Organization
Organization Name:ESLAM MOHAMED MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:MOHINUR
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRDAVSI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:347-988-1145
Mailing Address - Street 1:983 E 12TH ST # M1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3667
Mailing Address - Country:US
Mailing Address - Phone:347-988-1145
Mailing Address - Fax:
Practice Address - Street 1:983 E 12TH ST # M1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3667
Practice Address - Country:US
Practice Address - Phone:347-988-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty