NPIMap

Individual provider Active NPI

Keith Richard Forlenza, PA-C

  • Physician Assistant
  • Whitestone, NY
National Provider Identifier
1003242165
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
154-23 25TH Ave.
Whitestone, NY 11357
Phone
(917) 974-2089
NPI assigned
Sep 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

154-23 25TH Ave.
Whitestone, NY 11357

Mailing address

154-23 25TH Ave.
Whitestone, NY 11357
Phone (917) 974-2089

Other practice location 1

259 1st St
Mineola, NY 11501-3957
Phone (516) 663-2384

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kforlenza285209@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140722000233 NY Practitioner - Physician Assistant 2860618212 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Medical CurrentSince Sep 1, 2014 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Winthrop Community Medical Affiliates, P.C. CurrentSince May 1, 2018 Accepting new patients
St. Francis Hospital CurrentSince Aug 12, 2014 Accepting new patients
Good Samaritan Hospital CurrentSince Sep 1, 2014 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
St Francis Hospital United States Catholic Conference CurrentSince Aug 12, 2014 Accepting new patients
White Plains Hospital Medical Center Past Accepting new patients

Locations

700 Hicksville Rd
Ste 204
Bethpage, NY 11714
Phone (516) 576-5812

1300 Franklin Ave
Ste ML6
Garden City, NY 11530
Phone (516) 353-1900

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

120 Mineola Blvd
Ste 300
Mineola, NY 11501
Phone (516) 553-4400

120 Mineola Blvd
Ste 600
Mineola, NY 11501
Phone (516) 663-4525

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1003242165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154-23 25TH AVE.",
            "city": "WHITESTONE",
            "state": "NY",
            "postal_code": "11357",
            "telephone_number": "917-974-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154-23 25TH AVE.",
            "city": "WHITESTONE",
            "state": "NY",
            "postal_code": "11357",
            "telephone_number": "917-974-2089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "259 1st St",
            "address_purpose": "LOCATION",
            "city": "Mineola",
            "state": "NY",
            "postal_code": "115013957",
            "country_code": "US",
            "telephone_number": "516-663-2384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORLENZA",
        "first_name": "KEITH",
        "middle_name": "RICHARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-20",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kforlenza285209@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "259 1st St",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115013957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Whitestone, NY

Sources for this page

Verify at the official NPI Registry.