Izzeldin Abdelrahman Khogali Elmubarak

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1650 Grand Concourse
Bronx, NY 10457-7697

Phone

(646) 463-1935

NPI assigned

Jul 19, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: ielmubarak28766@direct.bostonchildrens.org
• Direct secure messaging: ielmubarak3026785@carolinashealthcaresystem.direct-ci.com

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.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  NPD (past)

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1629621602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 SELWYN AVE APT 20D",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577697",
            "telephone_number": "646-463-1935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMUBARAK",
        "first_name": "IZZELDIN",
        "middle_name": "ABDELRAHMAN KHOGALI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "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": []
}

• Abdu A Elmetwally, PT
• Elmhurst RX Inc
• Elmhurst RX Inc (Fulton Care Pharmacy)
• Elmhurst Star Pharmacy Inc. (Concourse Pharmcy)
• Fadima Mohamed Warsame Elmi, MD
• Elizabeth Elohim
• Tarek Elrafei, D.O.
• Omnia Elrefaei, MD
• Mariam Elsafty
• Elisabeth C Elsinger, DPM

• Student in an Organized Health Care Education/Training Program in Bronx, NY
• Providers in Bronx, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.