Individual provider Active NPI

Ranjan Roy, M.D.

  • Rheumatology Physician
  • Northport, NY
National Provider Identifier
1174615140
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
01042355A Issued in IN
Practice address
79 Middleville Rd
VA Medical Center, Medical Service (111)
Northport, NY 11768-2200
Phone
(631) 261-4400
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 01042355A IN Primary

Addresses

Primary practice location

79 Middleville Rd
VA Medical Center, Medical Service (111)
Northport, NY 11768-2200

Mailing address

79 Middleville Rd
VA Medical Center, Medical Service (111)
Northport, NY 11768-2200
Phone (631) 261-4400

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
I20110519000375 NY Order and Referring Only - Internal MedicinePractitioner - Internal MedicinePractitioner - Rheumatology 2769668144

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01042355AINMDRheumatology Physician

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1174615140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 MIDDLEVILLE RD",
            "address_2": "VA MEDICAL CENTER, MEDICAL SERVICE (111)",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117682200",
            "telephone_number": "631-261-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 MIDDLEVILLE RD",
            "address_2": "VA MEDICAL CENTER, MEDICAL SERVICE (111)",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117682200",
            "telephone_number": "631-261-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "RANJAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IN",
            "license": "01042355A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, NY

Sources for this page

Verify at the official NPI Registry.