NPIMap

Organization Active NPI

Professional Evaluation Medical Group

  • Exclusive Provider Organization
  • Hicksville, NY
National Provider Identifier
1104960962
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
147150 Issued in NY
Legal business name
PROFESSIONAL EVALUATION MEDICAL GROUP
Practice address
380 S Broadway
Hicksville, NY 11801-5033
Phone
(516) 935-4378
Fax
(516) 931-3117
NPI assigned
Feb 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Authorized official

Name
Mr. James Michael Sheehy
Title
Executive Director
Phone
(516) 935-4378

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X 147150 NY Primary

Addresses

Primary practice location

380 S Broadway
Hicksville, NY 11801-5033

Mailing address

380 S Broadway
Hicksville, NY 11801-5033
Phone (516) 935-4378

National Provider Directory

National Provider Directory
Tax ID family
Professional Evaluation Medical Group2 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.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1104960962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 S BROADWAY",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118015033",
            "telephone_number": "516-935-4378",
            "fax_number": "516-931-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 S BROADWAY",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118015033",
            "telephone_number": "516-935-4378",
            "fax_number": "516-931-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EVALUATION MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "SHEEHY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "516-935-4378",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NY",
            "license": "147150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; 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.