Organization Active NPI

Physician Affiliate Group of New York PC

  • Registered Dietitian
  • New York, NY
National Provider Identifier
1013375526
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
001002 Issued in NY
Legal business name
PHYSICIAN AFFILIATE GROUP OF NEW YORK PC
Practice address
506 Lenox Ave
New York, NY 10037-1802
Phone
(212) 939-2467
NPI assigned
Jan 29, 2016
Last updated
Sep 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Authorized official

Name
Mr. Michael H. Lewensohn
Title
Medical Credentialing
Phone
(914) 403-8985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 001002 NY Primary

Addresses

Primary practice location

506 Lenox Ave
New York, NY 10037-1802

Mailing address

506 Lenox Ave
New York, NY 10037-1802

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200721001270 NY Part B Supplier - Clinic/Group Practice 4688098833 Receives reassigned benefits from 2,377 practitioners
Practice locations: New York, NY; Brooklyn, NY; Bronx, NY

National Provider Directory

National Provider Directory

Locations

1649 Surf Ave
Brooklyn, NY 11224
Phone (718) 616-6040

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

55 W 125th St
Rm 1001
New York, NY 10027

Practitioners & affiliated clinicians

Practitioners 2,396

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 2,396

NPI Registry JSON

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

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1013375526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-939-2467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN AFFILIATE GROUP OF NEW YORK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-29",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "LEWENSOHN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "MEDICAL CREDENTIALING",
        "authorized_official_telephone_number": "914-403-8985",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "001002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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.