Individual provider Active NPI

Miriam Rachel Raport, D.O.

  • Geriatric Medicine (Internal Medicine) Physician
  • New York, NY
National Provider Identifier
1013948777
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
215452 Issued in NY
Practice address
36 7TH Ave
Suite 416
New York, NY 10011-6609
Phone
(212) 243-7522
Fax
(646) 486-4681
NPI assigned
Jul 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 215452 NY Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 61945 NJ

Addresses

Primary practice location

36 7TH Ave
Suite 416
New York, NY 10011-6609

Mailing address

36 7TH Ave
Suite 416
New York, NY 10011-6609
Phone (212) 243-7522

Other identifiers 3

IdentifierTypeStateIssuer
61945OtherNJLICENSE
02364583MedicaidNY
215452OtherNYLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080808000596 NY Practitioner - Geriatric MedicinePractitioner - Internal Medicine 7012081086 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61945NJMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jul 1, 2012 Accepting new patients
Bimc Faculty Practice Past Accepting new patients
St Vincents Hospital and Medical Center Past Accepting new patients
Bimc Faculty Practice Past Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

1554 Northern Blvd
Manhasset, NY 11030
Phone (516) 390-9242

300 Community Dr
Manhasset, NY 11030

10 Union Sq E
New York, NY 10003
Phone (212) 253-6800

10 Union Sq E
#3
New York, NY 10003
Phone (212) 420-4145

972 Brush Hollow Rd
Westbury, NY 11590

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013948777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 7TH AVE",
            "address_2": "SUITE 416",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100116609",
            "telephone_number": "212-243-7522",
            "fax_number": "646-486-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 7TH AVE",
            "address_2": "SUITE 416",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100116609",
            "telephone_number": "212-243-7522",
            "fax_number": "646-486-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAPORT",
        "first_name": "MIRIAM",
        "middle_name": "RACHEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "215452",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "61945",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "61945",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02364583",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "215452",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.