Provider Demographics
NPI:1063278604
Name:MOBASSERA, UMME (MD)
Entity type:Individual
Prefix:
First Name:UMME
Middle Name:
Last Name:MOBASSERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 SMITH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4308
Mailing Address - Country:US
Mailing Address - Phone:215-758-7786
Mailing Address - Fax:
Practice Address - Street 1:1 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-2254
Practice Address - Country:US
Practice Address - Phone:516-432-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ31451208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice