Individual provider Active NPI

Moustafa Abouelela, PHYSICAL THERAPY

  • Physical Therapist
  • Middle Village, NY
National Provider Identifier
1073701025
Registry record updated Sep 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
027999 Issued in NY
Practice address
6188 Dry Harbor Rd
5E
Middle Village, NY 11379-1535
Phone
(646) 724-4459
Fax
(718) 424-5070
NPI assigned
Oct 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 027999 NY Primary

Addresses

Primary practice location

6188 Dry Harbor Rd
5E
Middle Village, NY 11379-1535

Mailing address

6188 Dry Harbor Rd
5E
Middle Village, NY 11379-1535
Phone (646) 724-4459

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090210000200 NY Practitioner - Physical Therapist in Private Practice 5092870915 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

871 E Tremont Ave
Bronx, NY 10460-4207
Phone (718) 414-6763

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
MK Healthcare Medical PC CurrentSince Nov 1, 2021 Accepting new patients
High Line Rehab PT PC Physical Therapist CurrentSince Jul 15, 2021 Accepting new patients
Suny Downstate Medical Center PastSince Dec 10, 2008 Accepting new patients
Floating Lotus LLC Past Accepting new patients

Locations

39 W 56th St
Apt 5
New York, NY 10019
Phone (212) 600-0220

5629 Metropolitan Ave
Ridgewood, NY 11385
Phone (718) 418-0300

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1073701025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6188 DRY HARBOR RD",
            "address_2": "5E",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113791535",
            "telephone_number": "646-724-4459",
            "fax_number": "718-424-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6188 DRY HARBOR RD",
            "address_2": "5E",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113791535",
            "telephone_number": "646-724-4459",
            "fax_number": "718-424-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABOUELELA",
        "first_name": "MOUSTAFA",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-03",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "027999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middle Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.