Bushwick Professional Medical Services of New York LLC
Organization Active NPI Vascular Surgery Physician · Brooklyn, NY
NPI 1003393299 · NPPES record last updated Jul 20, 2018
Key facts
- NPI
- 1003393299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- Legal business name
- BUSHWICK PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
- Practice address
- 441 Knickerbocker Ave Ste a
Brooklyn, NY 11237-4508 - Phone
- (347) 773-2684
- Fax
- (718) 261-3893
- NPI assigned
- Jul 20, 2018
- Organization subpart
- No
Authorized official
- Name
- Yan Katsnelson
- Title
- Owner
- Phone
- (224) 318-0118
Practitioners 31
-
Masahiko Satoda, MD
-
Randi Harris, M.D.
-
Yan Katsnelson, M.D.
-
Sanjeev Saxena, MD
-
Peter L Smith, M.D.
-
Michael C Banker, MD
-
Stuart L Blackwood, M.D.
-
Dallas Broadway, M.D.
-
Richard Di Fiore, MD
-
Glenn Rory Faust, MD
-
Alexander Gart, MD
-
Stephen G Hurst, M.D.
-
Gina L. Louie, MD
-
Eugene Palchik, MD
-
Jeromy Ryan Patterson, M.D.
-
Aaron Dov Reichman, M.D.
-
J Timothy Riley, M D
-
McCarthy George Smith, M.D.
-
Stephanie Spano, MD
-
Jacob White, MD
-
Ian Jermaine Wilson, M.D.
-
Sean Yetman, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2161180 | Bushwick Professional Medical Services of | Certificate of waiver | Jan 28, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190111001240 | NY | Part B Supplier - Clinic/Group Practice | 0648516617 |
Receives reassigned benefits from 29 practitioners Practice locations: Brooklyn, NY; Stony Brook, NY; New York, NY; Bronx, NY; Bethpage, NY |
National Provider Directory
Locations
4025 Hempstead Tpke
Ste D
Bethpage, NY 11714
Phone (347) 537-2755
1949 Westchester Ave
Ste D
Bronx, NY 10462
Phone (347) 537-2755
2444 86th St
Ste D
Brooklyn, NY 11214
Phone (347) 537-2755
864 Pennsylvania Ave
Ste A
Brooklyn, NY 11207
Phone (347) 773-2684
2350 Nesconset Hwy
Ste D
Stony Brook, NY 11790
Phone (347) 537-2755
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | Yes |
Addresses
Primary practice location
441 Knickerbocker Ave Ste a
Brooklyn, NY 11237-4508
Mailing address
PO Box 32
Northbrook, IL 60065-0032
Phone (847) 593-8460
Other providers in Brooklyn, NY
- Bushwick Economic Development Corp
- Bushwick Medical of New York LLC
- Bushwick Orthodontic Studio
- Bushwick Orthodontics PLLC
- Bushwick Pharmacy, Inc.
- Bushwick Quality Supplies LLC
- Bushwick Stuyvesant Heights Home Attendants, Inc.
- Bushwick Therapy Mental Health Counseling, PLLC
- Yamit Busidan
- Barbara Adelia Busillo
All providers in Brooklyn, NY · Vascular Surgery Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.