Basic Information
| Provider Information | |||||||||
| NPI: | 1952596231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADWAN | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | YOUSRY | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 SENECA TPKE | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133231027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157381671 | ||||||||
| FaxNumber: | 3157380942 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 SENECA TPKE | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133231027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157381671 | ||||||||
| FaxNumber: | 3157380942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 029526 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 03356232 | 05 | NY | MEDICAID |