NPIMap

Individual provider Active NPI

Alexandros Demetrios Polydorides, M.D., PH.D.

  • Anatomic Pathology Physician
  • New York, NY
National Provider Identifier
1063617751
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
248507 Issued in NY
Practice address
1 Gustave L Levy PL
Mount Sinai Medical Center
New York, NY 10029-6500
Phone
(212) 241-9140
Fax
(212) 828-4188
NPI assigned
Jun 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X 248507 NY Primary
Anatomic Pathology Physician 207ZP0101X 4301089297 MI

Addresses

Primary practice location

1 Gustave L Levy PL
Mount Sinai Medical Center
New York, NY 10029-6500

Mailing address

1 Gustave L Levy PL
Box 1194
New York, NY 10029-6500
Phone (212) 241-9140

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
I20090312000203 NY Practitioner - Pathology 8820180565 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 241-8014

Hospital & facility affiliations

  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024
  • Mount Sinai West Hospital, New York, NY, CCN 330046

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
248507NYMDLicensed Practical Nurse
4301089297MIMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based CurrentSince Sep 5, 2014 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Fpa Hospital Based CurrentSince Sep 5, 2014 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 1, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 1, 2023 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

5 E 98th St
Fl 6
New York, NY 10029
Phone (212) 241-2221

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

1468 Madison Ave
New York, NY 10029
Phone (212) 241-0440

Networks

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

Organizations & group practices 7

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 8

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": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238025600000",
    "number": "1063617751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "address_2": "BOX 1194",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296500",
            "telephone_number": "212-241-9140",
            "fax_number": "212-828-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "address_2": "MOUNT SINAI MEDICAL CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296500",
            "telephone_number": "212-241-9140",
            "fax_number": "212-828-4188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLYDORIDES",
        "first_name": "ALEXANDROS",
        "middle_name": "DEMETRIOS",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2009-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NY",
            "license": "248507",
            "primary": true
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "MI",
            "license": "4301089297",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.