Individual provider Active NPI

Antwan I Haskoor, MD

  • Pediatrics Physician
  • Glendale, NY
National Provider Identifier
1104997295
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
175230 Issued in NY
Practice address
69 43 Central Ave
Glendale, NY 11385
Phone
(718) 497-6711
Fax
(718) 418-8248
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 175230 NY Primary

Addresses

Primary practice location

69 43 Central Ave
Glendale, NY 11385

Mailing address

69 43 Central Ave
Glendale, NY 11385
Phone (718) 497-6711

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
I20161107001733 NY Practitioner - Pediatric Medicine 0941589337 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Oct 10, 2016 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

26901 76th Ave
New Hyde Park, NY 11040
Phone (718) 470-3000

300 Community Dr
Plandome, NY 11030

9525 Queens Blvd
Rego Park, NY 11374
Phone (718) 286-1000

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: antwanhaskoor@nslijmedgr.allscriptsdirect.net

Organizations & group practices 1

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104997295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 43 CENTRAL AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-497-6711",
            "fax_number": "718-418-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 43 CENTRAL AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-497-6711",
            "fax_number": "718-418-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKOOR",
        "first_name": "ANTWAN",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "175230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, NY

Sources for this page

Verify at the official NPI Registry.