Organization Active NPI

Seaford Family Practice-Internal Medicine PC

  • Primary Care Clinic/Center
  • Seaford, NY
National Provider Identifier
1184768517
Registry record updated Nov 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
07653 Issued in NY
Legal business name
SEAFORD FAMILY PRACTICE-INTERNAL MEDICINE PC
Practice address
3921 Merrick Rd
Seaford, NY 11783-2823
Phone
(516) 785-0660
Fax
(516) 785-1099
NPI assigned
Feb 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2013

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

Authorized official

Name
Mrs. Myrna R Elfenbein
Title
Office Administrator
Phone
(516) 785-0660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 07653 NY Primary

Addresses

Primary practice location

3921 Merrick Rd
Seaford, NY 11783-2823

Mailing address

3921 Merrick Rd
Seaford, NY 11783-2823
Phone (516) 785-0660

Other identifiers 1

IdentifierTypeStateIssuer
07653OtherNYSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041215001053 NY Part B Supplier - Clinic/Group Practice 4880651330 Receives reassigned benefits from 1 practitioner
Practice locations: Seaford, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0159010Seaford Family Prac/Internal Med PC3921 Merrick Road, Seaford, NY 11783Certificate of waiverApr 26, 2027

National Provider Directory

National Provider Directory

Locations

3921 Merrick Rd
Seaford, NY 11783
Phone (516) 781-7771

3921 Merrick Rd
Ste 1
Seaford, NY 11783
Phone (516) 785-0660

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383523200000",
    "number": "1184768517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 MERRICK RD",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117832823",
            "telephone_number": "516-785-0660",
            "fax_number": "516-785-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3921 MERRICK RD",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117832823",
            "telephone_number": "516-785-0660",
            "fax_number": "516-785-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAFORD FAMILY PRACTICE-INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-18",
        "last_updated": "2013-11-04",
        "status": "A",
        "authorized_official_last_name": "ELFENBEIN",
        "authorized_official_first_name": "MYRNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "516-785-0660",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "07653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "07653",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seaford, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.