New York Ispine Specialist Medical P.C.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

NEW YORK ISPINE SPECIALIST MEDICAL P.C.

Practice address

600 Northern Blvd
Great Neck, NY 11021-5206

Phone

(516) 441-5739

NPI assigned

Jul 15, 2015

Last updated

Sep 9, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Madan K Raj

Title

MD

Phone

(516) 441-5739

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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.

• Madankumar Raj, M.D.

  • Pain Medicine Physician
  • Great Neck, NY
  • NPI 1528029162
  Medicare reassignment NPD

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1144604539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 HOLIDAY POND RD",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117531154",
            "telephone_number": "516-441-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215206",
            "telephone_number": "516-441-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK ISPINE SPECIALIST MEDICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "RAJ",
        "authorized_official_first_name": "MADAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "516-441-5739"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine Physician in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Pain Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.