Active NPI
Joseph P Mouallem, MD, JD
- Psychiatry Physician
- Brooklyn, NY
National Provider Identifier
1740635804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 294231
- Practice address
- 26 Court St Ste 2125
Brooklyn, NY 11242-1136 - Phone
- (212) 757-7732
- Fax
- (646) 354-7629
- NPI assigned
- Apr 26, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 294231 | NY | Primary |
Addresses
Primary practice location
26 Court St Ste 2125
Brooklyn, NY 11242-1136
Mailing address
135 Amity St Apt 3B
Brooklyn, NY 11201-6115
Phone (212) 757-7732
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6372780 | Other | NY | AETNA STUDENT HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 22, 2020 through Jul 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Juris Doctor, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 294231 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710806400000",
"number": "1740635804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 AMITY ST APT 3B",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112016115",
"telephone_number": "212-757-7732",
"fax_number": "646-354-7629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 COURT ST STE 2125",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112421136",
"telephone_number": "212-757-7732",
"fax_number": "646-354-7629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUALLEM",
"first_name": "JOSEPH",
"middle_name": "P",
"credential": "MD, JD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-26",
"last_updated": "2024-03-19",
"certification_date": "2024-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "294231",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA STUDENT HEALTH",
"identifier": "6372780",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.