Healthcare Provider Details

I. General information

NPI: 1609856889
Provider Name (Legal Business Name): MOSSAMMAT MOSFEKA MANSUR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE SUITE # 18
HEMPSTEAD NY
11550-8115
US

IV. Provider business mailing address

230 HILTON AVE SUITE # 18
HEMPSTEAD NY
11550-8115
US

V. Phone/Fax

Practice location:
  • Phone: 516-565-5200
  • Fax:
Mailing address:
  • Phone: 516-565-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number234659
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number234659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: