Active NPI
Pederson-Krag Center Inc
- Multi-Specialty Clinic/Center
- Huntington, NY
National Provider Identifier
1013964170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- PEDERSON-KRAG CENTER INC
- Practice address
- 55 Horizon Dr
Huntington, NY 11743-4436 - Phone
- (631) 920-8000
- Fax
- (631) 920-8167
- NPI assigned
- May 27, 2006
- Last updated
- Mar 3, 2015
- 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
- Ms. Jacqueline Rivera-Herrera
- Title
- VP of Finance for Clinical Services
- Phone
- (347) 542-4217
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | NU | Primary |
Addresses
Primary practice location
55 Horizon Dr
Huntington, NY 11743-4436
Mailing address
142-02 20TH Avenue
3Rd Floor
Flushing, NY 11351
Phone (718) 559-0555
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W02691 | Other | NY | BLUE CROSS |
| 040403001029 | Other | NY | FIDELIS |
| 01819272 | Medicaid | NY | |
| DA1829 | Other | NY | RAILROAD MEDICARE |
| 0007155064 | Other | NY | AETNA |
| 002875 | Other | NY | BLUE CROSS |
| 01556532 | Medicaid | NY | |
| 01934014 | Medicaid | NY | |
| 02717417 | Medicaid | NY | |
| 11662 | Other | NY | VYTRA |
| 3189305 | Other | NY | GHI |
| 0007525706 | Other | NY | AETNA |
| 00337004 | Medicaid | NY | |
| 1042840-8842 | Other | NY | BEACON HEALTH STRATEGIES |
| 0007632069 | Other | NY | AETNA |
| 001728 | Other | NY | BLUE CROSS |
| 038080 | Other | NY | VALUE OPTIONS |
| ANC1285 | Other | NY | OXFORD |
Other names 1
- PEDERSON-KRAG CENTER, INC
National Provider Directory
National Provider DirectoryLocations
17 Flowerfield
PK Contin Treat Pro
Saint James, NY 11780
Phone (631) 584-5320
240 Long Island Ave
Wyandanch, NY 11798
Phone (631) 782-6200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1425340800000",
"number": "1013964170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142-02 20TH AVENUE",
"address_2": "3RD FLOOR",
"city": "FLUSHING",
"state": "NY",
"postal_code": "11351",
"telephone_number": "718-559-0555",
"fax_number": "718-445-7111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 HORIZON DR",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117434436",
"telephone_number": "631-920-8000",
"fax_number": "631-920-8167"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDERSON-KRAG CENTER INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-27",
"last_updated": "2015-03-03",
"status": "A",
"authorized_official_last_name": "RIVERA-HERRERA",
"authorized_official_first_name": "JACQUELINE",
"authorized_official_title_or_position": "VP OF FINANCE FOR CLINICAL SERVICES",
"authorized_official_telephone_number": "347-542-4217",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "W02691",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "040403001029",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01819272",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DA1829",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007155064",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "002875",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01556532",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01934014",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02717417",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA",
"identifier": "11662",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "3189305",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007525706",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00337004",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEACON HEALTH STRATEGIES",
"identifier": "1042840-8842",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007632069",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "001728",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "038080",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "ANC1285",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PEDERSON-KRAG CENTER, INC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Huntington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.