Provider Demographics
NPI:1053770610
Name:HABLAS, MOHAMED HASSAN BASIOUNY
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:HASSAN BASIOUNY
Last Name:HABLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2720
Mailing Address - Country:US
Mailing Address - Phone:929-888-1727
Mailing Address - Fax:
Practice Address - Street 1:10 VISTA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3017
Practice Address - Country:US
Practice Address - Phone:929-888-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist