Active NPI
Ibrahim Farouk Abdelfatah, PHYSICAL THERAPIST
- Physical Therapist
- Staten Island, NY
National Provider Identifier
1013101609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 018280-1
- Practice address
- 2052 Richmond Rd
Staten Island, NY 10306 - Phone
- (718) 434-4600
- Fax
- (718) 434-6261
- NPI assigned
- Aug 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 018280-1 | NY | Primary |
Addresses
Primary practice location
2052 Richmond Rd
Staten Island, NY 10306
Mailing address
PO Box 60219
Staten Island, NY 10306
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018280-1 | NY | MD | Physical Therapist |
| 018280 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aesculapius Medical PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Brooklyn, NY
- NPI 1730194325
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507248000000",
"number": "1013101609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60219",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2052 RICHMOND RD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10306",
"telephone_number": "718-434-4600",
"fax_number": "718-434-6261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABDELFATAH",
"first_name": "IBRAHIM",
"middle_name": "FAROUK",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-28",
"last_updated": "2017-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "018280-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.