Individual provider Active NPI

Mosammat Ireen Alam

  • Physician Assistant
  • Jamaica, NY
National Provider Identifier
1316645765
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
029702-01 Issued in NY
Practice address
9420 Guy R Brewer Blvd
Jamaica, NY 11451-0001
Phone
(718) 262-2000
NPI assigned
Feb 15, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 029702-01 NY Primary

Addresses

Primary practice location

9420 Guy R Brewer Blvd
Jamaica, NY 11451-0001

Mailing address

9420 Guy R Brewer Blvd
Jamaica, NY 11451-0001

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230322000970 NY Practitioner - Physician Assistant 3870967458 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Modern Physician Services PCGroup PAC ID 6204140544, 55 clinicians
Josef Schenker MD PCGroup PAC ID 8022335330, 57 clinicians

Practice addresses (Care Compare)

3733 82ND St
Jackson Heights, NY 11372-7031
Phone (646) 604-8190

4426 18TH Ave
Brooklyn, NY 11204-1201
Phone (718) 635-9700

6122 Fresh Pond Rd
Middle Village, NY 11379-1040
Phone (718) 502-3000

6402 108TH St
Forest Hills, NY 11375-1604
Phone (212) 734-6621

6721 Fresh Pond Rd
Ridgewood, NY 11385-4562
Phone (929) 468-9920

68 Graham Ave
Brooklyn, NY 11206-4017
Phone (646) 604-8130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
029702NYMDPhysical Therapist
029702-01NYMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: dxl9007@direct.nyp.org

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1676419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1316645765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9420 GUY R BREWER BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114510001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9420 GUY R BREWER BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114510001",
            "telephone_number": "718-262-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALAM",
        "first_name": "MOSAMMAT",
        "middle_name": "IREEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-15",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "029702-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.