Active NPI
Mamoun Alhajjoumaa, PA
- Medical Physician Assistant
- Elmhurst, NY
National Provider Identifier
1285876466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 013215
- Practice address
- 40-35 95 Street
Elmhurst, NY 11368-6200 - Phone
- (718) 803-8463
- Fax
- (718) 205-4928
- NPI assigned
- Apr 2, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 013215 | NY | Primary |
Addresses
Primary practice location
40-35 95 Street
Elmhurst, NY 11368-6200
Mailing address
40-35 95 Street
Elmhurst, NY 11368-6200
Phone (718) 803-8463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151214000081 | NY | Order and Referring Only - Physician Assistant | 5991006108 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238630400000",
"number": "1285876466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40-35 95 STREET",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113686200",
"telephone_number": "718-803-8463",
"fax_number": "718-205-4928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40-35 95 STREET",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113686200",
"telephone_number": "718-803-8463",
"fax_number": "718-205-4928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALHAJJOUMAA",
"first_name": "MAMOUN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-02",
"last_updated": "2009-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "013215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.