Individual provider Active NPI

Alexander Vidershayn

  • Diagnostic Radiology Physician
  • Brooklyn, NY
National Provider Identifier
1053362319
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
225962 Issued in NY
Practice address
2943 Brighton 4TH St
Apt 5B
Brooklyn, NY 11235-8520
Phone
(718) 630-7000
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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 225962 NY Primary

Addresses

Primary practice location

2943 Brighton 4TH St
Apt 5B
Brooklyn, NY 11235-8520

Mailing address

2943 Brighton 4TH St
Apt 5B
Brooklyn, NY 11235-8520

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address avidershayn128241@nyumc.direct-ci.com Other NYU Langone

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
I20060615000128 NY Practitioner - Diagnostic Radiology 4183636020 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Icahn School of Medicine at Mount Sinai, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

150 55TH St
Brooklyn, NY 11220-2508
Phone (718) 630-7000

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Sep 1, 2015 Accepting new patients
New York University CurrentSince Sep 1, 2015 Accepting new patients
New York City Health and Hospitals Corporation Current Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Mar 23, 2024 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Mar 23, 2024 Accepting new patients

Locations

8714 5th Ave
Brooklyn, NY 11209
Phone (718) 630-8600

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

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

50 Water St
Fl 3
New York, NY 10004

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

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

Networks

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

Interoperability endpoints

  • Direct secure messaging: avidershayn128241@nyumc.direct-ci.com

Organizations & group practices 5

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 9

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1053362319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2943 BRIGHTON 4TH ST",
            "address_2": "APT 5B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112358520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2943 BRIGHTON 4TH ST",
            "address_2": "APT 5B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112358520",
            "telephone_number": "718-630-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDERSHAYN",
        "first_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "225962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "avidershayn128241@nyumc.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "NYU Langone",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Other",
            "address_1": "2943 Brighton 4th St",
            "address_2": "APT 5B",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112358520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.