Provider Demographics
NPI:1154207397
Name:ELESSAWY, HUSAM (PT,DPT)
Entity type:Individual
Prefix:
First Name:HUSAM
Middle Name:
Last Name:ELESSAWY
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WALCH PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4007
Mailing Address - Country:US
Mailing Address - Phone:347-982-4273
Mailing Address - Fax:
Practice Address - Street 1:150 GREAVES LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2114
Practice Address - Country:US
Practice Address - Phone:718-715-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist