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MK HEALTHCARE MEDICAL PC
NPI 1316426299
Specialist in Ridgewood, NY

Active since August 10, 2018CLIA 33D1063185 · Waiver
5629 METROPOLITAN AVE, RIDGEWOOD, NY 11385(718) 418-0300(718) 418-0301 Get Directions Write a Review

NPPES record last updated: September 16, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 16, 2022, Aug 10, 2018 (2 updates tracked since 2018).

About Mk Healthcare Medical Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MK HEALTHCARE MEDICAL PC (NPI 1316426299) is a healthcare organization registered as a specialist in Ridgewood, New York and active in the NPI registry since August 2018. The organization holds a CLIA Waiver certificate valid through January 7, 2027 and lists Paul Ambar, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1316426299
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameMK HEALTHCARE MEDICAL PC
Location Address5629 METROPOLITAN AVERidgewood, NY 11385
Mailing Address5629 Metropolitan AveRidgewood, NY 11385-1975 · (718) 418-0300 · Fax (718) 418-0301
Phone(718) 418-0300
Fax(718) 418-0301
Organization SubpartNo
Authorized OfficialPaul AmbarCredentialing Manager · (917) 748-1913
Enumeration DateAugust 10, 2018
Last NPPES UpdateSeptember 16, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 16, 2022
✔ NPI 1316426299 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NY · 149503
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

5629 METROPOLITAN AVE, Ridgewood, NY 11385
Open in Google Maps ↗

Other Identifiers 2

Medicaid00825003NY
Other149503NY · License

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D1063185

Mk Healthcare Medical PC · Ridgewood, NY
Active · expires Jan 7, 2027
CLIA Number33D1063185
Laboratory TypePhysician Office
Certificate Effective DateJanuary 8, 2025
Certificate Expiration DateJanuary 7, 2027
Laboratory DirectorDr. Joseph F. Damore
Laboratory Phone(718) 418-0300
Laboratory LocationMk Healthcare Medical PC56-29 Metropolitan Avenue, Ridgewood, NY 11385
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RIDGEWOOD MEDICAL DIAGNOSTIC PC
Family Medicine
5629 METROPOLITAN AVE
RIDGEWOOD, NY 11385
Queens County (718) 648-5858
MELINDA MABUTAS PT
Physical Therapist
5629 METROPOLITAN AVE
RIDGEWOOD, NY 11385
Queens County (718) 576-3277
NY EMPIRE MEDICAL PC
Clinic/Center (Multi-Specialty)
5629 METROPOLITAN AVE
RIDGEWOOD, NY 11385
Queens County (718) 418-0300
KIM CAPENA
Physical Therapist
5629 METROPOLITAN AVE
RIDGEWOOD, NY 11385
Queens County (718) 418-0300
PANKAJ K MAMTORA MD
Internal Medicine
5629 METROPOLITAN AVE
RIDGEWOOD, NY 11385
Queens County (718) 418-0300
DR. STELLA ILYAEV M.D.
Internal Medicine
5629 METROPOLITAN AVE
RIDGEWOOD, NY 11385
Queens County (718) 418-0300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mk Healthcare Medical PC's NPI number?

The NPI number for Mk Healthcare Medical PC is 1316426299. It was assigned to this organization in the NPPES registry on August 10, 2018.

Where is Mk Healthcare Medical PC located?

Mk Healthcare Medical PC is located at 5629 Metropolitan Ave, Ridgewood, NY 11385. The listed phone number is (718) 418-0300.

What is Mk Healthcare Medical PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Mk Healthcare Medical PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D1063185) is associated with this NPI, valid through January 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mk Healthcare Medical PC was last updated on September 16, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.