Individual provider Active NPI

Russell James Pepe, MD

  • General Practice Physician
  • New Hyde Park, NY
National Provider Identifier
1043849706
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
324291 Issued in NY
Practice address
27005 76TH Ave
New Hyde Park, NY 11040-1402
Phone
(718) 470-4475
Fax
(718) 962-2239
NPI assigned
Apr 5, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 324291 NY Primary

Addresses

Primary practice location

27005 76TH Ave
New Hyde Park, NY 11040-1402

Mailing address

27005 76TH Ave
New Hyde Park, NY 11040-1402
Phone (718) 470-4475

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
I20230913003520 NY Practitioner - General Practice 9335503010 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
324291NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Essen Medical Associates, PC CurrentSince Jul 31, 2023 Accepting new patients
Essen Medical Associates, PC CurrentSince Jul 31, 2023 Accepting new patients
Essen Medical Urgicare, PLLC CurrentSince Jul 31, 2023 Accepting new patients

Locations

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

1550 Dr Martin L King Jr Blvd
Bronx, NY 10452
Phone (347) 269-2366

8989 Union Tpke
Glendale, NY 11385
Phone (718) 480-6207

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1586044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1043849706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27005 76TH AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401402",
            "telephone_number": "718-470-4475",
            "fax_number": "718-962-2239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27005 76TH AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401402",
            "telephone_number": "718-470-4475",
            "fax_number": "718-962-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPE",
        "first_name": "RUSSELL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-05",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "324291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

Verify at the official NPI Registry.