Active NPI
Issam Malkoun, OPTICIAN
- Optician
- Boothwyn, PA
National Provider Identifier
1740328418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 23273485
- Practice address
- 3103 Chichester Ave
Boothwyn, PA 19061-3117 - Phone
- (610) 494-4320
- NPI assigned
- Feb 2, 2007
- Last updated
- May 2, 2011
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 23273485 | PA | Primary |
Addresses
Primary practice location
3103 Chichester Ave
Boothwyn, PA 19061-3117
Mailing address
427 South Ave
Media, PA 19063-3215
Phone (610) 566-9272
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0134700001 | Other | NSC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23273485 | PA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304294400000",
"number": "1740328418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "427 SOUTH AVE",
"city": "MEDIA",
"state": "PA",
"postal_code": "190633215",
"telephone_number": "610-566-9272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3103 CHICHESTER AVE",
"city": "BOOTHWYN",
"state": "PA",
"postal_code": "190613117",
"telephone_number": "610-494-4320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALKOUN",
"first_name": "ISSAM",
"name_prefix": "Mr.",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2011-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "PA",
"license": "23273485",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NSC",
"identifier": "0134700001",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Boothwyn, PA
- Manoucher Jalali, MD
- Jeff Quip, Inc. (The Home Care Network, Jefferson Health System - Rehab Equipment)
- Joel S. Goldberg
- Nancy Elizabeth Jordan, PT
- Manuel T. Lim, MD
- Steven Marinakis, DMD
- Timothy A Martin, D.C.
- Louis M. Micolucci, R.PH.
- Modern Dental Professionals Philadelpha PC (Pro-dent)
- Lauren Moyer, M.S., CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.