Provider Demographics
NPI:1962063784
Name:IBRAHIM, AHMED MOSTAFA (DPT)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:MOSTAFA
Last Name:IBRAHIM
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 1:2750 E 12TH ST APT 6G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4664
Mailing Address - Country:US
Mailing Address - Phone:929-431-4637
Mailing Address - Fax:
Practice Address - Street 1:2750 E 12TH ST APT 6G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4664
Practice Address - Country:US
Practice Address - Phone:929-431-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist