Healthcare Provider Details

I. General information

NPI: 1184515389
Provider Name (Legal Business Name): MOUNIRA MEFTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 ROUTE 146
ALTAMONT NY
12009-4409
US

IV. Provider business mailing address

31 MILDRED LN # 12110
LATHAM NY
12110-3501
US

V. Phone/Fax

Practice location:
  • Phone: 518-861-5141
  • Fax:
Mailing address:
  • Phone: 347-200-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP136616
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: