Active NPI
Kumar Madom, MD
- Pediatrics Physician
- Port Jefferson Station, NY
National Provider Identifier
1174612964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 115212
- Practice address
- 5225 Nesconset Hwy
Suite 35
Port Jefferson Station, NY 11776 - Phone
- (631) 331-3232
- Fax
- (631) 928-4910
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 115212 | NY | Primary |
Addresses
Primary practice location
5225 Nesconset Hwy
Suite 35
Port Jefferson Station, NY 11776
Mailing address
PO Box 395
Mt Sinai, NY 11766
Phone (631) 331-3232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115212 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174612964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 395",
"city": "MT SINAI",
"state": "NY",
"postal_code": "11766",
"telephone_number": "631-331-3232",
"fax_number": "631-928-4910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 NESCONSET HWY",
"address_2": "SUITE 35",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "11776",
"telephone_number": "631-331-3232",
"fax_number": "631-928-4910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADOM",
"first_name": "KUMAR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "115212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.