NPIMap

Organization Active NPI

First Choice Medical PLLC

  • Internal Medicine Physician
  • Holbrook, NY
National Provider Identifier
1043355159
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
164959 Issued in NY
Legal business name
FIRST CHOICE MEDICAL PLLC
Practice address
203 Union Ave
Holbrook, NY 11741-1704
Phone
(631) 585-5858
Fax
(631) 585-6362
NPI assigned
Feb 20, 2007
Last updated
Nov 14, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Authorized official

Name
Adeline Fontana
Title
Office Manager
Phone
(631) 585-5858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 164959 NY Primary

Addresses

Primary practice location

203 Union Ave
Holbrook, NY 11741-1704

Mailing address

203 Union Ave
Holbrook, NY 11741-1704
Phone (631) 585-5858

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000134 NY Part B Supplier - Clinic/Group Practice 1456241660 Receives reassigned benefits from 11 practitioners
Practice locations: Holbrook, NY

National Provider Directory

National Provider Directory

Locations

21 Eastport Manor Rd
Eastport, NY 11941
Phone (631) 325-2255

5 Eastport Manor Rd
Eastport, NY 11941
Phone (516) 325-2255

203 Union Ave
Holbrook, NY 11741
Phone (631) 585-5858

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1043355159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 UNION AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411704",
            "telephone_number": "631-585-5858",
            "fax_number": "631-585-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 UNION AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411704",
            "telephone_number": "631-585-5858",
            "fax_number": "631-585-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CHOICE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "FONTANA",
        "authorized_official_first_name": "ADELINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-585-5858"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "164959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holbrook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; 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.