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MUDATHIR OMOBONUOLA IBRAHIM MD
NPI 1710481791
Student in an Organized Health Care Education/Training Program in Brooklyn, NY

Active since March 22, 2018PECOS Enrolled
4802 10TH AVE, BROOKLYN, NY 11219(718) 283-6000 Get Directions Write a Review

NPPES record last updated: March 22, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mudathir Omobonuola Ibrahim Md NPPES

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

MUDATHIR OMOBONUOLA IBRAHIM MD (NPI 1710481791) is an individual student in an organized health care education/training program in Brooklyn, New York and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1710481791
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMUDATHIR OMOBONUOLA IBRAHIMCredential: MD
Location Address4802 10TH AVEBrooklyn, NY 11219-2916
Mailing Address4802 10th AveBrooklyn, NY 11219-2916 · (718) 283-6000
Phone(718) 283-6000
Sole ProprietorYes
Enumeration DateMarch 22, 2018
✔ NPI 1710481791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4802 10TH AVE, Brooklyn, NY 11219
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mudathir Omobonuola Ibrahim Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

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

CARLOS BUZZETTA
Legal Medicine
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-8961
LOBELYS A ANICET PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-5660
CHIAMAKA MEREMETOH MD
Student in an Organized Health Care Education/Training Program
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-6000
JESSE M. GALINA
Student in an Organized Health Care Education/Training Program
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-6000
DR. ABANOUB ALFY NAKHLA MD
Student in an Organized Health Care Education/Training Program
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-6000
CHRISTINE LI MD
Student in an Organized Health Care Education/Training Program
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-6000
MS. KATRINA W SOWERBY FNP
Nurse Practitioner (Family)
4802 10TH AVE, PRE-TESTING
BROOKLYN, NY 11219
Kings County (718) 283-7300
MAIMONIDES MEDICAL CENTER MAIMONIDES INFECTIOUS DISEASES FPP
Internal Medicine (Infectious Disease)
4802 10TH AVE
BROOKLYN, NY 11219
Kings County (718) 283-8773

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 Mudathir Ibrahim's NPI number?

The NPI number for Mudathir Ibrahim is 1710481791. It was assigned to this individual provider in the NPPES registry on March 22, 2018.

Where is Mudathir Ibrahim located?

Mudathir Ibrahim practices at 4802 10th Ave, Brooklyn, NY 11219. The listed phone number is (718) 283-6000.

What is Mudathir Ibrahim's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mudathir Ibrahim enrolled in Medicare?

Yes. Mudathir Ibrahim is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mudathir Ibrahim was last updated on March 22, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.