Individual provider Active NPI

Mohamed Shehab

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1417559774
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
040174 Issued in NY
Practice address
815 Gravesend Neck Rd
Brooklyn, NY 11223-5552
Phone
(929) 366-4284
NPI assigned
Nov 12, 2020
Last updated
Nov 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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 040174 NY Primary

Addresses

Primary practice location

815 Gravesend Neck Rd
Brooklyn, NY 11223-5552

Mailing address

815 Gravesend Neck Rd
Brooklyn, NY 11223-5552
Phone (929) 366-4284

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210310002150 NY Practitioner - Physical Therapist in Private Practice 4082020326 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
040174NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Oceanside Physical Therapy PC Physical Therapist CurrentSince Jul 21, 2024 Accepting new patients
Core Physical Therapy Services PC Physical Therapist CurrentSince Feb 1, 2021 Accepting new patients
Barakat PT PC Physical Therapist CurrentSince Aug 1, 2021 Accepting new patients
Way to Rehab PT PC CurrentSince Nov 1, 2021 Accepting new patients
Medicine Mobile PC CurrentSince Feb 1, 2021 Accepting new patients

Locations

1767 Southern Blvd
Bronx, NY 10460
Phone (718) 618-7558

2003 Coney Island Ave
Brooklyn, NY 11223
Phone (347) 394-1600

2900 Bragg St
Brooklyn, NY 11235
Phone (718) 615-9500

3364 Nostrand Ave
Brooklyn, NY 11229
Phone (347) 570-5348

5110 19th Ave
Brooklyn, NY 11204
Phone (718) 223-1800

631 Foster Ave
Brooklyn, NY 11230
Phone (718) 369-8200

Organizations & group practices 6

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": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1417559774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 GRAVESEND NECK RD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235552",
            "telephone_number": "929-366-4284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 GRAVESEND NECK RD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235552",
            "telephone_number": "929-366-4284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEHAB",
        "first_name": "MOHAMED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-12",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "040174",
            "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 Nov 12, 2020; 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.