Provider Demographics
NPI:1528948593
Name:ALAM, MEHJABIN
Entity type:Individual
Prefix:
First Name:MEHJABIN
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184-23 N CONDUIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11413
Mailing Address - Country:US
Mailing Address - Phone:929-342-9986
Mailing Address - Fax:
Practice Address - Street 1:69-70 GRAND CENTRAL PARKWAY
Practice Address - Street 2:FOREST HILLS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-263-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP136811313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility