Active NPI
Mohammad Ahmad Ennab, M.D
- Student in an Organized Health Care Education/Training Program
- Staten Island, NY
National Provider Identifier
1376335067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 475 Seaview Avenue
Department of Medicine
Staten Island, NY 10305 - Phone
- (718) 226-9000
- NPI assigned
- May 20, 2025
- Reactivated
- Aug 26, 2026
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
475 Seaview Avenue
Department of Medicine
Staten Island, NY 10305
Mailing address
475 Seaview Avenue
Department of Medicine
Staten Island, NY 10305
Phone (347) 515-9398
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787702400000",
"number": "1376335067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 SEAVIEW AVENUE",
"address_2": "DEPARTMENT OF MEDICINE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10305",
"telephone_number": "347-515-9398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 SEAVIEW AVENUE",
"address_2": "DEPARTMENT OF MEDICINE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "10305",
"telephone_number": "718-226-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNAB",
"first_name": "MOHAMMAD",
"middle_name": "AHMAD",
"name_prefix": "Mr.",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-20",
"last_updated": "2026-08-26",
"certification_date": "2026-08-26",
"deactivation_date": "2026-03-23",
"reactivation_date": "2026-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.