Individual
MR. MAMDOUH EZZAT IBRAHIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
211 MOSELEY RD, FAIRPORT, NY 14450-3060
(315) 744-7674
Mailing address
211 MOSELEY RD, FAIRPORT, NY 14450-3060
(315) 744-7674
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
344600000X
Taxi
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06779419
—
NY
Enumeration date
12/13/2021
Last updated
12/13/2021
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