Ghulam Mujtaba Mehmood, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00345000 Issued in NJ

Practice address

8002 Kew Gardens Rd
Kew Gardens, NY 11415-3600

Phone

(973) 922-0444

NPI assigned

Aug 15, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• CMG Medical Group I LLC

  • Family Medicine Physician
  • Manalapan, NJ
  • NPI 1942778014

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1871992875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 ZABRISKIE ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073074221",
            "telephone_number": "973-922-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8002 KEW GARDENS RD",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114153600",
            "telephone_number": "973-922-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHMOOD",
        "first_name": "GHULAM",
        "middle_name": "MUJTABA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-15",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017710",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "017710",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "017710",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00345000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariela Marzini, MS, SLP
• Ellen McBride
• Sean A McNair
• Mea Pharmacy Inc
• Lillian S Medina, CASAC-T
• Raysean Mercer
• Metro Medical Practice PC
• Metro Shoe Repair
• Metro-Optica Eyewear, Inc.
• Metropolitan Podiatry Associates PC

• Physician Assistant in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; 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.