Active NPI
Khaled Houssein Eleesily, PT,DPT
- Orthopedic Physical Therapist
- Brooklyn, NY
National Provider Identifier
1396924981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 014768-01
- Practice address
- 578 Fort Hill PL
3
Brooklyn, NY 11228-3608 - Phone
- (718) 926-3344
- NPI assigned
- Oct 30, 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 014768-01 | NY | Primary |
Addresses
Primary practice location
578 Fort Hill PL
3
Brooklyn, NY 11228-3608
Mailing address
424 Fingerboard Rd
Staten Island, NY 10305-3744
Phone (718) 926-3344
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014768-01 | NY | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583280000000",
"number": "1396924981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "424 FINGERBOARD RD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103053744",
"telephone_number": "718-926-3344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "578 FORT HILL PL",
"address_2": "3",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112283608",
"telephone_number": "718-926-3344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELEESILY",
"first_name": "KHALED",
"middle_name": "HOUSSEIN",
"credential": "PT,DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-30",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "NY",
"license": "014768-01",
"primary": true
}
],
"identifiers": [],
"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 Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.