Active NPI
Jackson Heights Medical Care PC
- Sleep Medicine (Internal Medicine) Physician
- Far Rockaway, NY
National Provider Identifier
1003250762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sleep Medicine (Internal Medicine) Physician
- Legal business name
- JACKSON HEIGHTS MEDICAL CARE PC
- Practice address
- 2008 Seagirt Blvd
Far Rockaway, NY 11691-2803 - Phone
- (718) 565-6880
- Fax
- (877) 796-4457
- NPI assigned
- Apr 24, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Carl A. Nicholeau
- Title
- Owner
- Phone
- (718) 344-5293
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sleep Medicine (Internal Medicine) Physician | 207RS0012X | Primary | ||
| Physical Therapist | 225100000X |
Addresses
Primary practice location
2008 Seagirt Blvd
Far Rockaway, NY 11691-2803
Mailing address
7535 31St Ave
Suite 200
East Elmhurst, NY 11370-1857
Phone (718) 565-6880
Other practice location 1
6315 Roosevelt Ave
Woodside, NY 11377-3641
Phone (718) 565-6880
Other practice location 2
3712 92nd St Fl 2
Jackson Heights, NY 11372-7930
Phone (718) 565-6880
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G100516770 | Other | NY | MEDICARE PROVIDER ID |
| 06748732 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
8610 Roosevelt Ave
Ste 2
Jackson Heights, NY 11372
6315 Roosevelt Ave
Woodside, NY 11377
Phone (718) 810-4717
Ownership & related parties
Subparts reporting this organization as parent 3
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Sleep Medicine (Internal Medicine) Physician
- East Elmhurst, NY
- NPI 1215349147
-
- Cardiovascular Disease Physician
- East Elmhurst, NY
- NPI 1023420957
-
- Sleep Medicine (Internal Medicine) Physician
- East Elmhurst, NY
- NPI 1073925905
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Jackson Heights, NY
- NPI 1407331200
-
- Cardiovascular Disease Physician
- Hewlett, NY
- NPI 1356398713
-
- Family Nurse Practitioner
- Brooklyn, NY
- NPI 1992323422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366761600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1724630400000",
"number": "1003250762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7535 31ST AVE",
"address_2": "SUITE 200",
"city": "EAST ELMHURST",
"state": "NY",
"postal_code": "113701857",
"telephone_number": "718-565-6880",
"fax_number": "718-565-3102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2008 SEAGIRT BLVD",
"city": "FAR ROCKAWAY",
"state": "NY",
"postal_code": "116912803",
"telephone_number": "718-565-6880",
"fax_number": "877-796-4457"
}
],
"practiceLocations": [
{
"address_1": "6315 Roosevelt Ave",
"address_purpose": "LOCATION",
"city": "Woodside",
"state": "NY",
"postal_code": "113773641",
"country_code": "US",
"telephone_number": "718-565-6880",
"fax_number": "877-796-4457",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3712 92nd St Fl 2",
"address_purpose": "LOCATION",
"city": "Jackson Heights",
"state": "NY",
"postal_code": "113727930",
"country_code": "US",
"telephone_number": "718-565-6880",
"fax_number": "877-796-4457",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "JACKSON HEIGHTS MEDICAL CARE PC",
"organizational_subpart": "NO",
"enumeration_date": "2013-04-24",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A",
"authorized_official_last_name": "NICHOLEAU",
"authorized_official_first_name": "CARL",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "718-344-5293"
},
"taxonomies": [
{
"code": "207RS0012X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Sleep Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER ID",
"identifier": "G100516770",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06748732",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Far Rockaway, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.