Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 014886-1 | NY |
N | 225100000X | Physical Therapist | 5501007336 | MI |
NPI | 1003050162 |
---|---|
Provider Name | Mr. Mohamed Ali Sadeia |
First Address | Staten Island, NY 10303-1730 |
Second Address | Staten Island, NY 10303-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 20/04/2009 |