Active NPI
Ajs Brookyln Medical Practice PC
- Clinic/Center
- Jamaica, NY
National Provider Identifier
1134594955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- AJS BROOKYLN MEDICAL PRACTICE PC
- Practice address
- 161-21 Jamaica Ave
7TH Floor
Jamaica, NY 11432 - Phone
- (718) 896-2500
- Fax
- (718) 459-8515
- NPI assigned
- Dec 4, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Donna Stidham
- Title
- Chief, Managed Care
- Phone
- (323) 436-5025
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
161-21 Jamaica Ave
7TH Floor
Jamaica, NY 11432
Mailing address
6255 W Sunset Blvd FL 21
Los Angeles, CA 90028-7422
Phone (323) 860-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131029000201 | NY | Part B Supplier - Clinic/Group Practice | 5395970362 |
Receives reassigned benefits from 27 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bronx, NY; New York, NY; Jamaica, NY; Far Rockaway, NY; Brooklyn, NY |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
16121 Jamaica Ave
Fl 7
Jamaica, NY 11432
Phone (718) 896-2500
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449187200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1568160000000",
"number": "1134594955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6255 W SUNSET BLVD FL 21",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900287422",
"telephone_number": "323-860-5200",
"fax_number": "833-241-7615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161-21 JAMAICA AVE",
"address_2": "7TH FLOOR",
"city": "JAMAICA",
"state": "NY",
"postal_code": "11432",
"telephone_number": "718-896-2500",
"fax_number": "718-459-8515"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AJS BROOKYLN MEDICAL PRACTICE PC",
"organizational_subpart": "NO",
"enumeration_date": "2015-12-04",
"last_updated": "2019-09-11",
"status": "A",
"authorized_official_last_name": "STIDHAM",
"authorized_official_first_name": "DONNA",
"authorized_official_title_or_position": "CHIEF, MANAGED CARE",
"authorized_official_telephone_number": "323-436-5025"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.