NPIMap

Organization Active NPI

Physio Logic Medicine, P.C.

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1013293588
Registry record updated Apr 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
241732 Issued in NY
Legal business name
PHYSIO LOGIC MEDICINE, P.C.
Practice address
409 Fulton Street
2ND Floor
Brooklyn, NY 11201
Phone
(718) 260-1000
Fax
(718) 260-0072
NPI assigned
Oct 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2015

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

Authorized official

Name
Dr. Jonathann C Kuo, M.D.
Title
President
Phone
(718) 260-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 241732 NY Primary

Addresses

Primary practice location

409 Fulton Street
2ND Floor
Brooklyn, NY 11201

Mailing address

281 Broadway
2ND Floor
New York, NY 10007-1831
Phone (718) 260-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120127000847 NY Part B Supplier - Clinic/Group Practice 1355508664 Receives reassigned benefits from 4 practitioners
Practice locations: Brooklyn, NY
O20220322001289 NJ Part B Supplier - Clinic/Group Practice 1355508664 Receives reassigned benefits from 1 practitioner
Practice locations: Jersey City, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1319760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1013293588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 BROADWAY",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100071831",
            "telephone_number": "718-260-1000",
            "fax_number": "718-260-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 FULTON STREET",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11201",
            "telephone_number": "718-260-1000",
            "fax_number": "718-260-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIO LOGIC MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-28",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "KUO",
        "authorized_official_first_name": "JONATHANN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-260-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NY",
            "license": "241732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; 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.

Verify at the official NPI Registry.