NPIMap

Organization Active NPI

Highland Ophthalmology Associates LLC

  • Ophthalmology Physician
  • New Windsor, NY
National Provider Identifier
1184796591
Registry record updated Apr 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
HIGHLAND OPHTHALMOLOGY ASSOCIATES LLC
Practice address
104 Executive Drive
Suite 300
New Windsor, NY 12553
Phone
(845) 562-0138
Fax
(845) 562-0147
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2017

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

Authorized official

Name
Nancy J Ingersoll
Title
Office Manager
Phone
(845) 562-0138

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

104 Executive Drive
Suite 300
New Windsor, NY 12553

Mailing address

104 Executive Drive
Suite 300
New Windsor, NY 12553
Phone (845) 562-0138

Other identifiers 1

IdentifierTypeStateIssuer
02773480MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325001261 NY Part B Supplier - Clinic/Group Practice 4284526203 Receives reassigned benefits from 5 practitioners
Practice locations: New Windsor, NY

National Provider Directory

National Provider Directory

Locations

140 Executive Dr
New Windsor, NY 12553
Phone (845) 562-0138

140 Executive Dr
Ste 300
New Windsor, NY 12553
Phone (845) 562-0138

304 Fullerton Ave
Newburgh, NY 12550
Phone (845) 561-0907

Practitioners & affiliated clinicians

Practitioners 10

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1184796591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 EXECUTIVE DRIVE",
            "address_2": "SUITE 300",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "12553",
            "telephone_number": "845-562-0138",
            "fax_number": "845-562-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 EXECUTIVE DRIVE",
            "address_2": "SUITE 300",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "12553",
            "telephone_number": "845-562-0138",
            "fax_number": "845-562-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND OPHTHALMOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "INGERSOLL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "845-562-0138"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02773480",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Windsor, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; 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.