Healthcare Provider Details

I. General information

NPI: 1487577698
Provider Name (Legal Business Name): MUMOON KEISAREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8043 247TH ST
BELLEROSE NY
11426-1823
US

IV. Provider business mailing address

19815 HILLSIDE AVE
HOLLIS NY
11423-2128
US

V. Phone/Fax

Practice location:
  • Phone: 844-368-5548
  • Fax:
Mailing address:
  • Phone: 844-368-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number670468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: