Provider Demographics
NPI:1215028964
Name:MAMOON, NAHREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAHREEN
Middle Name:
Last Name:MAMOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 168TH PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3629
Mailing Address - Country:US
Mailing Address - Phone:718-558-0280
Mailing Address - Fax:718-558-0290
Practice Address - Street 1:8731 168TH PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3629
Practice Address - Country:US
Practice Address - Phone:646-541-9885
Practice Address - Fax:646-541-9885
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02493465Medicaid
NY02493465Medicaid