Mini Susan Mammen

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F344251 Issued in NY

Practice address

310 E Shore Rd
Great Neck, NY 11023-2410

Phone

(516) 482-8657

NPI assigned

May 20, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: minimammen@nslijmedgr.allscriptsdirect.net

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1780241398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BEECH ST",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110403825",
            "telephone_number": "718-598-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E SHORE RD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110232410",
            "telephone_number": "516-482-8657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMMEN",
        "first_name": "MINI",
        "middle_name": "SUSAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-20",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "NY",
            "license": "F344251",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F344251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sohail Malkoukian, PHARMD
• Susan Marie Maloney, M.D.
• Theodora Malonoukos, PHARM.D.
• Chetan Malpe, M.D.
• Susan Maltser, DO
• Beena Mancheril, FNP - BC
• Jordana Sage Mandel
• Julia Mandelblat, M.D.
• Gary P Mandell, PH.D.
• Tiana Manfred

• Family Nurse Practitioner in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2019; 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.