NPIMap

Organization Active NPI

Molina Healthcare of New York, Inc.

  • Nurse Practitioner
  • North Syracuse, NY
National Provider Identifier
1134622970
Registry record updated Sep 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MOLINA HEALTHCARE OF NEW YORK, INC.
Practice address
5232 Witz Dr
North Syracuse, NY 13212
Phone
(888) 562-5442
Fax
(562) 499-6171
NPI assigned
Mar 16, 2018
Last updated
Sep 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2019

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

Authorized official

Name
Gina Turley
Title
VP-Care Connection
Phone
(888) 562-5442

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

5232 Witz Dr
North Syracuse, NY 13212

Mailing address

200 Oceangate Ste 100
Long Beach, CA 90802-4317
Phone (888) 562-5442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211210001127 NY Part B Supplier - Clinic/Group Practice 8628468337 Receives reassigned benefits from 69 practitioners
Practice locations: Bronx, NY; North Syracuse, NY

National Provider Directory

National Provider Directory

Locations

2900 Exterior St
Ste 202
Bronx, NY 10463
Phone (607) 238-5357

5232 Witz Dr
North Syracuse, NY 13212
Phone (315) 632-5960

Practitioners & affiliated clinicians

Practitioners 75

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 75

NPI Registry JSON

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569542400000",
    "number": "1134622970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE STE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "888-562-5442",
            "fax_number": "562-499-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5232 WITZ DR",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "13212",
            "telephone_number": "888-562-5442",
            "fax_number": "562-499-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLINA HEALTHCARE OF NEW YORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2019-09-27",
        "status": "A",
        "authorized_official_last_name": "TURLEY",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "VP-CARE CONNECTION",
        "authorized_official_telephone_number": "888-562-5442"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.

Verify at the official NPI Registry.