Individual provider Active NPI

Amal A Rahman, M.D.

  • Pediatrics Physician
  • Staten, NY
National Provider Identifier
1063855682
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
285508 Issued in NY
Practice address
475 Seaview Avenue
Department of Pediatrics
Staten, NY 10305-3436
Phone
(718) 226-9360
NPI assigned
Apr 12, 2013
Last updated
Aug 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 285508 NY Primary
Hospitalist Physician 208M00000X 285508 NY

Addresses

Primary practice location

475 Seaview Avenue
Department of Pediatrics
Staten, NY 10305-3436

Mailing address

475 Seaview Avenue
Department of Pediatrics
Staten, NY 10305-3436
Phone (718) 226-9360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160811001449 NY Practitioner - Pediatric Medicine 9537453667 Reassigns benefits to 1 organization
I20170511000269 NJ Practitioner - Pediatric Medicine 9537453667

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Hospitalist CurrentSince Aug 20, 2023 Accepting new patients
North Shore - Lij Medical PC CurrentSince Aug 20, 2023 Accepting new patients
Staten Island University Hospital Past Accepting new patients

Locations

300 Community Dr
Manhasset, NY 11030

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: arahman67730@northwell.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1063855682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVENUE",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "STATEN",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVENUE",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "STATEN",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHMAN",
        "first_name": "AMAL",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-12",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "285508",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "285508",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.