Pankaj K Mamtora, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

183635 Issued in NY

Practice address

5629 Metropolitan Ave
Ridgewood, NY 11385-1975

Phone

(718) 418-0300

Fax

(718) 418-0301

NPI assigned

Oct 19, 2006

Last updated

Jun 2, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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

• MK Healthcare Medical PC

  • Specialist
  • Ridgewood, NY
  • NPI 1316426299
  Medicare reassignment NPD

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1467534842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5629 METROPOLITAN AVE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113851975",
            "telephone_number": "718-418-0300",
            "fax_number": "718-418-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5629 METROPOLITAN AVE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113851975",
            "telephone_number": "718-418-0300",
            "fax_number": "718-418-0301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26808 Union Tpke",
            "address_purpose": "LOCATION",
            "city": "Glen Oaks",
            "state": "NY",
            "postal_code": "110041351",
            "country_code": "US",
            "telephone_number": "718-418-0300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMTORA",
        "first_name": "PANKAJ",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "183635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BS BC ON NY",
            "identifier": "29I692",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01456968",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roy Mahesh
• Simon Malak
• Rabia Malik
• Stacie Malner
• Mariya Mamkin, D.D.S.
• Nikki Mananedakis
• Manav Pharmacy Inc
• Lauren Mandel, LCSW
• Sharon Mapp-Davis, RN
• Margo Drug Corp (Madison Drugs)

• Internal Medicine Physician in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.

Verify at the official NPI Registry.