NPIMap

Organization Active NPI

Excella Medicine PC

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1174812812
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
170543 Issued in NY
Legal business name
EXCELLA MEDICINE PC
Practice address
4915 Broadway
Suite 1G
New York, NY 10034-3119
Phone
(212) 544-9513
Fax
(212) 544-0402
NPI assigned
Apr 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Authorized official

Name
Michael PerezNPI 1215906078
Title
MD
Phone
(212) 544-9513

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 170543 NY Primary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 170543 NY

Addresses

Primary practice location

4915 Broadway
Suite 1G
New York, NY 10034-3119

Mailing address

4915 Broadway
Suite 1G
New York, NY 10034-3119
Phone (212) 544-9513

Other identifiers 2

IdentifierTypeStateIssuer
P00633190OtherNYMEDICARE RAILROAD
01196487MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1174812812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 BROADWAY",
            "address_2": "SUITE 1G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100343119",
            "telephone_number": "212-544-9513",
            "fax_number": "212-544-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 BROADWAY",
            "address_2": "SUITE 1G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100343119",
            "telephone_number": "212-544-9513",
            "fax_number": "212-544-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLA MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "212-544-9513"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "170543",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "170543",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00633190",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01196487",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.