Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 236625 | NY |
NPI | 1124157284 |
---|---|
Provider Name | Mahmoud A Ibrahim |
First Address | Westbury, NY 11590-1740 |
Second Address | Manhasset, NY 11030-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I46734 | (02) |