Organization Active NPI

Mill Basin Medical Services PC

  • Specialist
  • White Plains, NY
National Provider Identifier
1164454658
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MILL BASIN MEDICAL SERVICES PC
Practice address
222 Bloomingdale Rd
Suite 400
White Plains, NY 10605-1513
Phone
(914) 644-9276
NPI assigned
Jul 7, 2006
Last updated
Apr 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Ms. Corey Korba
Title
Billing Manager
Phone
(914) 644-9276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

222 Bloomingdale Rd
Suite 400
White Plains, NY 10605-1513

Mailing address

3915 Avenue V
Suite 104
Brooklyn, NY 11234-5156
Phone (718) 252-8440

Other identifiers 1

IdentifierTypeStateIssuer
00725457MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070516000531 NY Part B Supplier - Clinic/Group Practice 3476442880 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

3915 Avenue V
#104
Brooklyn, NY 11234
Phone (718) 252-8440

222 Bloomingdale Rd
Ste 400
White Plains, NY 10605
Phone (914) 644-9276

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1164454658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 AVENUE V",
            "address_2": "SUITE 104",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345156",
            "telephone_number": "718-252-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 BLOOMINGDALE RD",
            "address_2": "SUITE 400",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051513",
            "telephone_number": "914-644-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL BASIN MEDICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "KORBA",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "914-644-9276",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00725457",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.