NPIMap

Organization Active NPI

Broadway Medical Services PC

  • Specialist
  • Yonkers, NY
National Provider Identifier
1083853360
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
BROADWAY MEDICAL SERVICES PC
Practice address
75 S Broadway
Yonkers, NY 10701-4004
Phone
(914) 376-7767
Fax
(914) 376-7106
NPI assigned
Feb 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

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

Authorized official

Name
Richard Khalil, MDNPI 1912011107
Title
Owner
Phone
(914) 376-7767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

75 S Broadway
Yonkers, NY 10701-4004

Mailing address

PO Box 740
Yonkers, NY 10703-0740
Phone (914) 376-7767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090521000164 NY Part B Supplier - Clinic/Group Practice 2466501408 Receives reassigned benefits from 2 practitioners
Practice locations: Yonkers, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2008084Broadway Medical Services, PC75 South Broadway, Yonkers, NY 10701Certificate of waiverJun 2, 2028

National Provider Directory

National Provider Directory

Locations

311 W 231st St
Bronx, NY 10463
Phone (718) 601-8400

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546387200000",
    "number": "1083853360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107030740",
            "telephone_number": "914-376-7767",
            "fax_number": "914-376-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 S BROADWAY",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107014004",
            "telephone_number": "914-376-7767",
            "fax_number": "914-376-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY MEDICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2019-01-02",
        "status": "A",
        "authorized_official_last_name": "KHALIL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-376-7767",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.