Fordham Professional Medical Services of New York LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

FORDHAM PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC

Practice address

11 E Fordham Rd Ste a
Bronx, NY 10468-5406

Phone

(847) 593-8460

Fax

(224) 235-4652

NPI assigned

Apr 2, 2018

Organization subpart

No

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

Authorized official

Name

Yan Katsnelson, M.D.

Title

Owner

Phone

(224) 318-0118

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522627200000",
    "number": "1124524970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WAINWRIGHT DR STE 110",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621919",
            "telephone_number": "224-318-0118",
            "fax_number": "224-235-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 E FORDHAM RD STE A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104685406",
            "telephone_number": "847-593-8460",
            "fax_number": "224-235-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORDHAM PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-02",
        "last_updated": "2018-04-02",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "YAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-318-0118",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fordham Medical PC
• Fordham Optical Inc
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• Fordham Plaza Dental Associates
• Fordham Plaza Pharmacy Inc
• Fordham Road Dental PC
• Fordham Road Pharmacy Inc.
• Fordham Road RX Inc
• Fordham Tremont
• Fordham Tremont CMHC

• Vascular Surgery Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Vascular Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; 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.