Healthcare Provider Details

I. General information

NPI: 1366384307
Provider Name (Legal Business Name): MS. MARIAM M MOUNIR JR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11655 QUEENS BLVD STE 216
FOREST HILLS NY
11375-6527
US

IV. Provider business mailing address

11655 QUEENS BLVD STE 216
FOREST HILLS NY
11375-6527
US

V. Phone/Fax

Practice location:
  • Phone: 212-804-7659
  • Fax: 888-975-7704
Mailing address:
  • Phone: 212-804-7659
  • Fax: 888-975-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: