Imtisal Tabbassum

Primary specialty

Social WorkerTaxonomy code 104100000X

License

105488 Issued in NY

Practice address

98120 Queens Blvd Ste 1C
Rego Park, NY 11374-4414

Phone

(718) 830-0246

NPI assigned

Jan 27, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Imtisal Tabbassum Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1023609682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 LYON ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115803101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98120 QUEENS BLVD STE 1C",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744414",
            "telephone_number": "718-830-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABBASSUM",
        "first_name": "IMTISAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "105488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW",
            "identifier": "105488",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IMTISAL",
            "last_name": "TABBASSUM",
            "credential": "LMSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Susan Collura Schiliro DPT PT CHT PC
• Nadine B. Sutton, APN PMHNP-BC
• Kristina Casey Suyunova
• Palina Suyunova, D.D.S.
• Synapse Medical P.L.L.C.
• Jasmine Tabibi, PHARM.D.
• Magdy S Tadros, DDS
• Maria Antonia Taibo-Armstrong
• Yelena Takhalova, OTR/L
• Cindy Tam, OTR/L

• All providers in Rego Park, NY
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.