Aldad Medical PC
Organization Active NPI Psychiatry Physician · Philadelphia, PA
NPI 1154072585 · NPPES record last updated Mar 28, 2023
Key facts
- NPI
- 1154072585
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- ALDAD MEDICAL PC
- Practice address
- 100 S Juniper St FL 3
Philadelphia, PA 19107-1316 - Phone
- (516) 505-7200
- NPI assigned
- Jan 18, 2022
- Organization subpart
- No
Authorized official
- Name
- Tamir Aldad
- Title
- Ceo
- Phone
- (516) 505-7200
Other NPIs with the same Medicare PAC ID 4
Practitioners 7
-
Tamir Aldad, M.D.
-
Francisco Davila, LCSW
-
Molly Christensen, APRN, PMHNP-BC
-
Alisha Martin, PMHNP-BC
-
Sara Missaoui, PHYSICIAN ASSISTANT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220125001762 | PA | Part B Supplier - Clinic/Group Practice | 5395152201 |
Receives reassigned benefits from 2 practitioners Practice locations: Philadelphia, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
100 S Juniper St FL 3
Philadelphia, PA 19107-1316
Mailing address
510 Hempstead Tpke RM 203
West Hempstead, NY 11552-1152
Phone (516) 505-7200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD476522 | Other | PA | LICENSE |
NPI Registry JSON
{
"created_epoch": "1642464000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1679961600000",
"number": "1154072585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 HEMPSTEAD TPKE RM 203",
"city": "WEST HEMPSTEAD",
"state": "NY",
"postal_code": "115521152",
"telephone_number": "516-505-7200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S JUNIPER ST FL 3",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191071316",
"telephone_number": "516-505-7200"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALDAD MEDICAL PC",
"organizational_subpart": "NO",
"enumeration_date": "2022-01-18",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A",
"authorized_official_last_name": "ALDAD",
"authorized_official_first_name": "TAMIR",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "516-505-7200"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "MD476522",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.