New York Vascular Group, PLLC
Organization Active NPI Vascular Surgery Physician · Cornwall, NY
NPI 1073128971 · NPPES record last updated Feb 19, 2024
Key facts
- NPI
- 1073128971
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- Legal business name
- NEW YORK VASCULAR GROUP, PLLC
- Practice address
- 19 Laurel Ave Ste 102
Cornwall, NY 12518-1403 - Phone
- (845) 822-8100
- Fax
- (845) 822-8110
- NPI assigned
- Sep 9, 2020
- Organization subpart
- No
Authorized official
- Name
- Sae Hahm, MD
- Title
- Owner
- Phone
- (203) 262-9979
Practitioners 6
-
Mohamed Yousef Elsagga, D.O.
-
Sae Joon Hahm, M.D.
-
Jennifer Ann Jackson, RPAC
-
Jonathan Norton Bowman, M.D.
-
Jaime Strachan, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2230630 | New York Vascular Group PLLC | Certificate of waiver | Jul 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210210000909 | NY | Part B Supplier - Clinic/Group Practice | 5193130888 |
Receives reassigned benefits from 6 practitioners Practice locations: Cornwall, NY |
National Provider Directory
Locations
19 Laurel Ave
Ste 102
Cornwall, NY 12518
Phone (203) 210-6340
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | Yes |
Addresses
Primary practice location
19 Laurel Ave Ste 102
Cornwall, NY 12518-1403
Mailing address
6 Research Dr Ste 105
Shelton, CT 06484-6228
Phone (203) 210-6340
Other providers in Cornwall, NY
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- Uma Ballava Mishra
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- Leiah Marinka Munsey
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- Scott Newkirk
- Danielle O'Rourke
- Orange County Radiation Oncology
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- Jessica Orrego
All providers in Cornwall, NY · Vascular Surgery Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.