NPIMap

Organization Active NPI

Village Family Practice

  • Primary Care Clinic/Center
  • New York, NY
National Provider Identifier
1104182880
Registry record updated Apr 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
166998 Issued in NY
Legal business name
VILLAGE FAMILY PRACTICE
Practice address
30 5TH Ave
1E
New York, NY 10011-8859
Phone
(212) 477-1750
NPI assigned
Apr 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2012

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

Authorized official

Name
Jerry Clements, MDNPI 1285721662
Title
President
Phone
(212) 477-1750

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
Primary Care Clinic/Center 261QP2300X 166998 NY Primary

Addresses

Primary practice location

30 5TH Ave
1E
New York, NY 10011-8859

Mailing address

30 5TH Ave
1E
New York, NY 10011-8859
Phone (212) 477-1750

Other names 1

  • village travel medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Village Family Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

30 5th Ave
Apt 1E
New York, NY 10011
Phone (212) 477-1750

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1104182880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 5TH AVE",
            "address_2": "1E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118859",
            "telephone_number": "212-477-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 5TH AVE",
            "address_2": "1E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118859",
            "telephone_number": "212-477-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-06",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "CLEMENTS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-477-1750",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "166998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "village travel medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.