Provider Demographics
NPI:1679819908
Name:BLUE MOUNTAIN PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMAD ALY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-829-5089
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18044-1360
Mailing Address - Country:US
Mailing Address - Phone:610-829-5089
Mailing Address - Fax:484-898-0334
Practice Address - Street 1:241 N 13TH ST STE 201
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-829-5089
Practice Address - Fax:888-972-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431055207R00000X, 207RA0401X, 2084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA263713Medicare PIN