Individual provider Active NPI

Peter Steven Midulla, MD

  • Pediatric Surgery Physician
  • New York, NY
National Provider Identifier
1104892488
Registry record updated Feb 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
188585 Issued in NY
Practice address
5 E 98TH St
14TH FL
New York, NY 10029-6574
Phone
(212) 241-1656
Fax
(212) 534-2654
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 188585 NY Primary

Addresses

Primary practice location

5 E 98TH St
14TH FL
New York, NY 10029-6574

Mailing address

5 E 98TH St
Box 1259
New York, NY 10029-6501
Phone (212) 241-1608

Other identifiers 1

IdentifierTypeStateIssuer
01936185MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20031117000062 NY Practitioner - General SurgeryPractitioner - Pediatric Medicine 9537073382 Reassigns benefits to 2 organizations
I20230404001587 NJ Practitioner - General Surgery 9537073382 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
188585NYMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Pediatric Surgery CurrentSince Jan 1, 2013 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 1, 2013 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2013 Accepting new patients
Valley Physician Services PC CurrentSince Feb 1, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 1, 2013 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

140 E Ridgewood Ave
Ste 480N
Paramus, NJ 07652
Phone (201) 447-8151

3201 Kings Hwy
Brooklyn, NY 11234
Phone (718) 252-3000

7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-3915

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

5 E 98th St
Fl 14
New York, NY 10029
Phone (212) 241-7646

425 W 59th St
Ste 7B
New York, NY 10019
Phone (212) 523-8041

5 E 98th St
#1259
New York, NY 10029
Phone (212) 241-5871

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

5 E 98th St
Fl 10
New York, NY 10029
Phone (212) 241-2125

1468 Madison Ave
Fl 3
New York, NY 10029
Phone (212) 241-3355

Networks

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

Interoperability endpoints

  • Direct secure messaging: peter.midulla.1@5622.direct.athenahealth.com

Organizations & group practices 10

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": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360108800000",
    "number": "1104892488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 E 98TH ST",
            "address_2": "BOX 1259",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296501",
            "telephone_number": "212-241-1608",
            "fax_number": "212-241-5975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 E 98TH ST",
            "address_2": "14TH FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296574",
            "telephone_number": "212-241-1656",
            "fax_number": "212-534-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDULLA",
        "first_name": "PETER",
        "middle_name": "STEVEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2013-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "NY",
            "license": "188585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01936185",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.