NPIMap

Organization Active NPI

Alexandre B. de Moura MD PC

  • Specialist
  • Westbury, NY
National Provider Identifier
1881863447
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1994051 Issued in NY
Legal business name
ALEXANDRE B. DE MOURA MD PC
Practice address
761 Merrick Avenue
Westbury, NY 11590-9996
Phone
(516) 357-8777
Fax
(516) 357-7251
NPI assigned
Feb 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Mr. Alexandre B. De Moura, M.D.
Title
Medical Director
Phone
(516) 357-8777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 1994051 NY Primary

Addresses

Primary practice location

761 Merrick Avenue
Westbury, NY 11590-9996

Mailing address

761 Merrick Avenue
Westbury, NY 11590-9996
Phone (516) 357-8777

Other names 1

  • New York Spine Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080523000147 NY Part B Supplier - Clinic/Group Practice 5890864342 Receives reassigned benefits from 24 practitioners
Practice locations: Astoria, NY; Mineola, NY; New York, NY; Rego Park, NY; Rockville Centre, NY; Westbury, NY
O20241212003840 NJ Part B Supplier - Clinic/Group Practice 5890864342 Receives reassigned benefits from 1 practitioner
Practice locations: West Orange, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2007142Alexandre B de Moura MD PC761 Merrick Avenue, Westbury, NY 11590Certificate of waiverSep 26, 2027

National Provider Directory

National Provider Directory

Locations

622 Eagle Rock Ave
Ste 204
West Orange, NJ 07052

1101 Stewart Ave
Ste 1ES
Garden City, NY 11530
Phone (631) 776-0432

123 W 79th St
New York, NY 10024
Phone (212) 579-5814

9614 63rd Dr
Rego Park, NY 11374
Phone (718) 896-0111

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1881863447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 MERRICK AVENUE",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115909996",
            "telephone_number": "516-357-8777",
            "fax_number": "516-357-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 MERRICK AVENUE",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115909996",
            "telephone_number": "516-357-8777",
            "fax_number": "516-357-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXANDRE B. DE MOURA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "DE MOURA",
        "authorized_official_first_name": "ALEXANDRE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "516-357-8777",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "1994051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New York Spine Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westbury, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.