Individual provider Active NPI

Mohamed Hafad Elhamadany, PT, PHD

  • Pediatric Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1124336995
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
2236 Issued in ND
Practice address
530 Ovington Ave
Apt # 2R
Brooklyn, NY 11209-1725
Phone
(646) 549-8170
Fax
(718) 745-1492
NPI assigned
Sep 15, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 2236 ND Primary
Physical Therapist 225100000X 032846-1 NY

Addresses

Primary practice location

530 Ovington Ave
Apt # 2R
Brooklyn, NY 11209-1725

Mailing address

5433 Chestnut St
Grand Forks, ND 58201-8005
Phone (646) 549-8170

Other practice location 1

2810 19th Ave S
Grand Forks, ND 58201-5957
Phone (701) 222-3175

Other identifiers 1

IdentifierTypeStateIssuer
1482541MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120127000076 NY Practitioner - Physical Therapist in Private Practice 1951578293 Reassigns benefits to 1 organization
I20220802002681 ND Practitioner - Physical Therapist in Private Practice 1951578293 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
032846-1NYMDPhysical Therapist
2236NDMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
United Cerebral Palsy of New York City Inc CurrentSince Aug 30, 2011 Accepting new patients
Red Door Pediatric Therapy, Inc Physical Therapist CurrentSince Dec 13, 2024 Accepting new patients
Life Skills and Transition Center PastSince Apr 24, 2022 Accepting new patients
Solutions Counseling Services, Inc. PastSince Dec 13, 2024 Accepting new patients

Locations

2810 19th Ave S
Grand Forks, ND 58201
Phone (701) 222-3175

175 Lawrence Ave
Brooklyn, NY 11230
Phone (718) 436-7600

80 Maiden Ln
Fl 12
New York, NY 10038

Interoperability endpoints

  • Direct secure messaging: mohamed.elhamadany.p2@direct.ucpnyc.nextgenshare.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1124336995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5433 CHESTNUT ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582018005",
            "telephone_number": "646-549-8170",
            "fax_number": "718-745-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 OVINGTON AVE",
            "address_2": "APT # 2R",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112091725",
            "telephone_number": "646-549-8170",
            "fax_number": "718-745-1492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2810 19th Ave S",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582015957",
            "country_code": "US",
            "telephone_number": "701-222-3175",
            "fax_number": "701-222-3186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELHAMADANY",
        "first_name": "MOHAMED",
        "middle_name": "HAFAD",
        "name_prefix": "Dr.",
        "credential": "PT, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-15",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "ND",
            "license": "2236",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "032846-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1482541",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.