Individual provider Active NPI

Alexander Kucherov, M.D.

  • Reproductive Endocrinology Physician
  • Norwalk, CT
National Provider Identifier
1104106244
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
67246 Issued in CT
Practice address
761 Main Ave Ste 200
Norwalk, CT 06851-1080
Phone
(203) 750-7400
NPI assigned
Aug 21, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology Physician 207VE0102X 67246 CT Primary
Obstetrics & Gynecology Physician 207V00000X 280223 NY
Reproductive Endocrinology Physician 207VE0102X 280223 NY

Addresses

Primary practice location

761 Main Ave Ste 200
Norwalk, CT 06851-1080

Mailing address

17 Derby LN
Ossining, NY 10562-2702
Phone (845) 705-7335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150921002584 NY Practitioner - Obstetrics/Gynecology 7719294909 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67246CTMDReproductive Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jul 1, 2015 Accepting new patients
Montefiore Medical Center Obstetrics & Gynecology CurrentSince Jul 1, 2015 Accepting new patients
Illume Fertility, PLLC Reproductive Endocrinology Past Accepting new patients

Locations

3011 Boston Rd
Bronx, NY 10469
Phone (718) 547-6111

111 E 210th St
Bronx, NY 10467

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.

NPI Registry JSON

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

{
    "created_epoch": "1313884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1104106244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 DERBY LN",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105622702",
            "telephone_number": "845-705-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 MAIN AVE STE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068511080",
            "telephone_number": "203-750-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCHEROV",
        "first_name": "ALEXANDER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-21",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "CT",
            "license": "67246",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "280223",
            "primary": false
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "NY",
            "license": "280223",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.