Provider Demographics
NPI:1669610945
Name:ELDEFRAWI, MOHAMED M HASSIB (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:M HASSIB
Last Name:ELDEFRAWI
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:619 HOLLYWOOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2345
Mailing Address - Country:US
Mailing Address - Phone:347-414-6488
Mailing Address - Fax:866-363-9046
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:6TH FRANKLIN
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:346-414-6488
Practice Address - Fax:866-363-9046
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2010-12-09
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Provider Licenses
StateLicense IDTaxonomies
NY2517992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry