Active NPI
Coralys Mercedes Vega, MD
- Pediatrics Physician
- Elmhurst, NY
National Provider Identifier
1093853897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 220555
- Practice address
- 4053 75TH St
Elmhurst, NY 11373-1011 - Phone
- (718) 426-6270
- Fax
- (718) 504-5422
- NPI assigned
- Feb 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 220555 | NY | Primary |
Addresses
Primary practice location
4053 75TH St
Elmhurst, NY 11373-1011
Mailing address
4053 75TH St
Elmhurst, NY 11373-1011
Phone (718) 426-6270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02167191 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 220555 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgar Flores-Castillo, MD PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BGAEAA/Endpoint/BGAEAA
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093853897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4053 75TH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113731011",
"telephone_number": "718-426-6270",
"fax_number": "718-504-5422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4053 75TH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113731011",
"telephone_number": "718-426-6270",
"fax_number": "718-504-5422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VEGA",
"first_name": "CORALYS",
"middle_name": "MERCEDES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "220555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02167191",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.