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MUJTABA NP IN FAMILY HEALTH, P.C.
NPI 1639765704
Nurse Practitioner - Family in Corona, NY

Active since December 14, 2020CLIA 33D2173160 · Waiver
10426 ROOSEVELT AVE, CORONA, NY 11368(718) 533-0991(833) 969-0190 Get Directions Write a Review

NPPES record last updated: December 22, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 22, 2020, Dec 14, 2020 (2 updates tracked since 2020).

About Mujtaba Np In Family Health, P.c. NPPES

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

MUJTABA NP IN FAMILY HEALTH, P.C. (NPI 1639765704) is a healthcare organization registered as a family in Corona, New York and active in the NPI registry since December 2020. The organization holds a CLIA Waiver certificate valid through October 6, 2027 and lists Athar Mujtaba, Ceo/provider, as its authorized official.

NPPES Registry Identity

NPI1639765704
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameMUJTABA NP IN FAMILY HEALTH, P.C.
Location Address10426 ROOSEVELT AVECorona, NY 11368-2328
Mailing Address10426 Roosevelt AveCorona, NY 11368-2328 · (917) 982-5007
Phone(718) 533-0991
Fax(833) 969-0190
Organization SubpartNo
Authorized OfficialAthar MujtabaCeo/provider · (917) 982-5007
Enumeration DateDecember 14, 2020
Last NPPES UpdateDecember 22, 20202 updates tracked since enumeration
NPPES CertifiedDecember 22, 2020
✔ NPI 1639765704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
10426 ROOSEVELT AVE, Corona, NY 11368
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mujtaba Np In Family Health, P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mujtaba Np In Family Health, P.C., which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Athar Mujtaba, NP
Nurse Practitioner
NPI 1891355400
10426 ROOSEVELT AVE
Corona, NY 11368
(718) 533-0991
✔ PECOS✔ Accepts MedicareSame address
Assad Mujtaba, DNP, NP-C
Nurse Practitioner
NPI 1699230359
859 CLIFTON AVE STE H
Clifton, NJ 07013
(973) 200-2430
✔ PECOS✔ Accepts Medicare18 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 33D2173160

Mujtaba Np In Family Health PC · Corona, NY
Active · expires Oct 6, 2027
CLIA Number33D2173160
Laboratory TypePhysician Office
Certificate Effective DateOctober 7, 2025
Certificate Expiration DateOctober 6, 2027
Laboratory DirectorMr. Athar Mujtaba
Laboratory Phone(929) 463-7190
Laboratory LocationMujtaba Np In Family Health PC10426 Roosevelt Ave, Corona, NY 11368
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Mujtaba Np In Family Health, P.C.'s NPI number?

The NPI number for Mujtaba Np In Family Health, P.C. is 1639765704. It was assigned to this organization in the NPPES registry on December 14, 2020.

Where is Mujtaba Np In Family Health, P.C. located?

Mujtaba Np In Family Health, P.C. is located at 10426 Roosevelt Ave, Corona, NY 11368. The listed phone number is (718) 533-0991.

What is Mujtaba Np In Family Health, P.C.'s specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Mujtaba Np In Family Health, P.C. enrolled in Medicare?

Yes. Mujtaba Np In Family Health, P.C. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mujtaba Np In Family Health, P.C.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Mujtaba Np In Family Health, P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mujtaba Np In Family Health, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2173160) is associated with this NPI, valid through October 6, 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 Mujtaba Np In Family Health, P.C. was last updated on December 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.