MEDICARE: MOUREN MEGALY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	034787	NY

General Provider Information

NPI Number	:	1013884394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUREN MEGALY

Provider Business Mailing Address
First Line	:	697 ARDEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	697 ARDEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3326
Country	:	US
Telephone Number	:	347-638-5494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	10/21/2025

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Directions to “ MOUREN MEGALY ” Practice Location

Language	Start Address	Practice Location

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