NPIMap

Individual provider Active NPI

Maj L Wickstrom, M.D.

  • Diagnostic Radiology Physician
  • New York, NY
National Provider Identifier
1023075884
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
225207 Issued in NY
Practice address
560 1St Ave
New York, NY 10016-6402
Phone
(212) 263-0050
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 225207 NY Primary

Addresses

Primary practice location

560 1St Ave
New York, NY 10016-6402

Mailing address

24 Stonewall Cir
West Harrison, NY 10604-1117
Phone (914) 428-3223

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040524000511 NY Practitioner - Diagnostic Radiology 4880685247 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Northwestern University Feinberg Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York City Health and Hospitals CorporationGroup PAC ID 4183535305, 543 clinicians
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

227 Madison St
New York, NY 10002-7537
Phone (212) 238-7000

317 E 34TH St
New York, NY 10016-4974
Phone (212) 263-6419

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214
  • Long Island Community Hospital Hospital, Patchogue, NY, CCN 330141
  • Bellevue Hospital Center Hospital, New York, NY, CCN 330204

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation CurrentSince Apr 3, 2024 Accepting new patients
New York University CurrentSince Dec 1, 2012 Accepting new patients
New York University CurrentSince Dec 1, 2012 Accepting new patients
Nyumc Radiology Associates Diagnostic Radiology Past Accepting new patients
New York University Medical Center Faculty Practice Radiology Diagnostic Radiology Past Accepting new patients

Locations

50 Water St
Fl 3
New York, NY 10004

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

530 1st Ave
Fl 2
New York, NY 10016
Phone (212) 263-7216

317 E 34th St
New York, NY 10016
Phone (212) 263-9741

660 1st Ave
New York, NY 10016
Phone (212) 263-0001

560 1st Ave
Fl 2
New York, NY 10016
Phone (212) 263-5212

227 Madison St
New York, NY 10002
Phone (212) 238-7000

530 1st Ave
Ste 7B
New York, NY 10016
Phone (212) 263-7814

560 1st Ave
New York, NY 10016
Phone (212) 263-5362

9785 Queens Blvd
Rego Park, NY 11374
Phone (631) 360-0266

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

111 Broadway
Fl 2
Trinity, NY 10006
Phone (212) 263-9700

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

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

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1023075884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 STONEWALL CIR",
            "city": "WEST HARRISON",
            "state": "NY",
            "postal_code": "106041117",
            "telephone_number": "914-428-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "MAJ",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "225207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.