Individual provider Active NPI

Ihab Taha Elkoush, D.P.T

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1194747097
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
018307 Issued in NY
Practice address
1473 Sterling PL
Brooklyn, NY 11213
Phone
(718) 756-8979
Fax
(347) 663-8881
NPI assigned
Jul 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2018

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 018307 NY Primary

Addresses

Primary practice location

1473 Sterling PL
Brooklyn, NY 11213

Mailing address

1473 Sterling PL
Brooklyn, NY 11213-3001
Phone (718) 756-8979

Other identifiers 1

IdentifierTypeStateIssuer
0205336MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071231000012 NY Practitioner - Physical Therapist in Private Practice 5698855807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
018307NYMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527033600000",
    "number": "1194747097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1473 STERLING PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112133001",
            "telephone_number": "718-756-8979",
            "fax_number": "718-756-8979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1473 STERLING PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11213",
            "telephone_number": "718-756-8979",
            "fax_number": "347-663-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKOUSH",
        "first_name": "IHAB",
        "middle_name": "TAHA",
        "name_prefix": "Dr.",
        "credential": "D.P.T",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2018-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "018307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0205336",
            "state": "NY"
        }
    ],
    "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 May 23, 2018; 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.