NPIMap

Organization Active NPI

MM Medical Service PC

  • Specialist
  • Forest Hills, NY
National Provider Identifier
1104281286
Registry record updated Dec 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MM MEDICAL SERVICE PC
Practice address
76-55 Austin Street
Forest Hills, NY 11375-6948
Phone
(718) 897-2228
NPI assigned
Dec 16, 2015
Last updated
Dec 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2015

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

Authorized official

Name
Dr. Mehran Manouel, MDNPI 1942272547
Title
MD
Phone
(718) 897-2228

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

76-55 Austin Street
Forest Hills, NY 11375-6948

Mailing address

PO Box 230406
Great Neck, NY 11023-0406
Phone (718) 897-2228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160304000336 NY Part B Supplier - Clinic/Group Practice 2466758297 Receives reassigned benefits from 6 practitioners
Practice locations: Great Neck, NY; New York, NY; Forest Hills, NY; Bronx, NY

National Provider Directory

National Provider Directory

Locations

11103 77th Ave
Forest Hills, NY 11375

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450224000000",
    "number": "1104281286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230406",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110230406",
            "telephone_number": "718-897-2228",
            "fax_number": "718-897-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76-55 AUSTIN STREET",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113756948",
            "telephone_number": "718-897-2228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MM MEDICAL SERVICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A",
        "authorized_official_last_name": "MANOUEL",
        "authorized_official_first_name": "MEHRAN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "718-897-2228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.