Michael Gladstein, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

143678 Issued in NY

Practice address

640 Hawkins Ave
Lake Ronkonkoma, NY 11779-2324

Phone

(631) 737-0100

Fax

(631) 417-1117

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Dermatology

Education

New York University School of Medicine, 1979

Medicare assignment

May accept Medicare assignment

Group practices

Ji Medical PCGroup PAC ID 0749680395, 6 clinicians

Jal 28 LLCGroup PAC ID 5193262830, 12 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: michael.gladstein@merrylandhealth.ehi.direct-ci.com

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.

• Jal 28 LLC

  • Clinic/Center
  • Brooklyn, NY
  • NPI 1063278281
  Medicare reassignment Care Compare group NPD
• Ji Medical PC

  • Clinic/Center
  • Brooklyn, NY
  • NPI 1366035248
  Medicare reassignment Care Compare group NPD
• A Merryland Operating LLC

  • Adolescent Medicine (Family Medicine) Physician
  • Brooklyn, NY
  • NPI 1972848307
  Medicare reassignment NPD
• Be Well Primary Health Care Center, LLC

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1083623409
  Medicare reassignment NPD
• Arthur H. Gladstein MD PC

  • Dermatology Physician
  • Astoria, NY
  • NPI 1093111569
  NPD (past) Authorized official
• Lafayette Medical Office, PC

  • Podiatrist
  • Brooklyn, NY
  • NPI 1912004995
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1104848811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2792 OCEAN AVE FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112294731",
            "telephone_number": "833-635-2566",
            "fax_number": "833-635-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 HAWKINS AVE",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792324",
            "telephone_number": "631-737-0100",
            "fax_number": "631-417-1117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2792 Ocean Ave Fl 2",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112294731",
            "country_code": "US",
            "telephone_number": "833-635-2566",
            "fax_number": "833-635-2565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLADSTEIN",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "143678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01850673",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George D Emmons DPM PC
• Kian Gilardi
• Liane Marie Gilardi, BCCS
• Altagrace Gilbert Blanchard
• Vito Giovanniello, DDS
• GNLC Physical Therapy PLLC
• Wilson Gonzalez
• Kristy A Goodman, PT
• Paris Andressi Green
• Hayley Beth Gruber

• Dermatology Physician in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.