NPIMap

Individual provider Active NPI

San San Wynn, M.D.

  • Hematology & Oncology Physician
  • Roslyn, NY
National Provider Identifier
1083687289
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
220806 Issued in NY
Practice address
56 Hamilton Dr
Roslyn, NY 11576-3129
Phone
(718) 498-5754
Fax
(718) 498-0950
NPI assigned
Feb 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 220806 NY
Hematology & Oncology Physician 207RH0003X 220806 NY Primary

Addresses

Primary practice location

56 Hamilton Dr
Roslyn, NY 11576-3129

Mailing address

723 E 87TH St
Brooklyn, NY 11236-3620
Phone (718) 498-5754

Other identifiers 1

IdentifierTypeStateIssuer
01864988MedicaidNY

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
I20040324000126 NY Practitioner - Hematology/OncologyPractitioner - Internal Medicine 9638060007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Hematology Oncology Associates PCGroup PAC ID 1456243641, 474 clinicians

Practice addresses (Care Compare)

3016 30TH Dr
Astoria, NY 11102-1874
Phone (631) 751-3000

48 Route 25a
Smithtown, NY 11787-1431
Phone (631) 751-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000719NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
San San Wynn, M.D., P.C. Hematology & Oncology CurrentSince Nov 26, 2001 Accepting new patients
North Shore Hematology Oncology Associates PC CurrentSince Oct 1, 2024 Accepting new patients
CHS Physician Partners, P.C Past Accepting new patients

Locations

723 E 87th St
Brooklyn, NY 11236
Phone (516) 536-2211

3016 30th Dr
Long Island City, NY 11102
Phone (718) 728-3376

1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

Networks

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

Interoperability endpoints

  • Direct secure messaging: swynn710148@nyumc.direct-ci.com
  • Direct secure messaging: ssw9007@direct.nyp.org

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1083687289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 E 87TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363620",
            "telephone_number": "718-498-5754",
            "fax_number": "718-498-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 HAMILTON DR",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115763129",
            "telephone_number": "718-498-5754",
            "fax_number": "718-498-0950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "SAN SAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-08",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "220806",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "220806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01864988",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslyn, NY

Sources for this page

Verify at the official NPI Registry.