Individual provider Active NPI

Kevin Flatley

  • Student in an Organized Health Care Education/Training Program
  • Bronx, NY
National Provider Identifier
1164008058
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(516) 359-2577
NPI assigned
Mar 22, 2021
Last updated
Mar 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NY Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

330 Blacksmith Rd W
Levittown, NY 11756-3121
Phone (516) 359-2577

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
I20251029002635 NY Practitioner - Obstetrics/Gynecology 4981193083 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Albany Medical College of Union University, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

13640 Briarwick Dr
Building a Suite 110
Austin, TX 78729-1706

5402 Fort Hamilton Pkwy
FL 6
Brooklyn, NY 11219-4037

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Faculty Practice Plan CurrentSince Sep 17, 2025 Accepting new patients
MMC OB-GYN Faculty Practice Plan CurrentSince Sep 17, 2025 Accepting new patients

Locations

1616A Voorhies Ave
Brooklyn, NY 11235
Phone (718) 283-8225

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1164008058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BLACKSMITH RD W",
            "city": "LEVITTOWN",
            "state": "NY",
            "postal_code": "117563121",
            "telephone_number": "516-359-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "516-359-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLATLEY",
        "first_name": "KEVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.