Individual provider Active NPI

Sergey Zavilyansky, MD

  • Family Medicine Physician
  • Liverpool, NY
National Provider Identifier
1194770610
Registry record updated Sep 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
204742 Issued in NY
Practice address
5100 W Taft Rd
Suite 2T
Liverpool, NY 13088-3807
Phone
(315) 452-2828
Fax
(315) 452-2891
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 204742 NY Primary

Addresses

Primary practice location

5100 W Taft Rd
Suite 2T
Liverpool, NY 13088-3807

Mailing address

5100 W Taft Rd
Suite 2T
Liverpool, NY 13088-3807
Phone (315) 452-2828

Other identifiers 1

IdentifierTypeStateIssuer
01707515MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, PA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20050627001308 NY Practitioner - Family Practice 3274578562 Reassigns benefits to 1 organization
I20190425000760 NJ Practitioner - Family Practice 3274578562
I20230405003123 PA Practitioner - Addiction MedicinePractitioner - Family Practice 3274578562 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
204742NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical PC Family Medicine CurrentSince Jul 6, 2012 Accepting new patients
Greater Philadelphia Health Action Inc. Current Accepting new patients
Greater Philadelphia Health Action, Inc. CurrentSince Mar 1, 2023 Accepting new patients
North Medical PC Family Medicine Current Accepting new patients
Greater Philadelphia Health Action, Inc Family Medicine CurrentSince Mar 1, 2023 Accepting new patients
Park Avenue Medical Associates, P.C. PastSince Dec 4, 1999 Accepting new patients
Inspira Health Network Medical Group, P.C. Past Accepting new patients

Locations

5100 W Taft Rd
Ste 1P
Liverpool, NY 13088
Phone (315) 452-2829

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

7209 Buckley Rd
Liverpool, NY 13088
Phone (315) 299-5451

5501 Woodland Ave
Philadelphia, PA 19143
Phone (215) 724-4700

1401 S 31st St
#2
Philadelphia, PA 19146

4510 Frankford Ave
Philadelphia, PA 19124
Phone (215) 744-1302

432 N 6th St
Philadelphia, PA 19123
Phone (215) 627-8000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347580800000",
    "number": "1194770610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 2T",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2828",
            "fax_number": "315-452-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 2T",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2828",
            "fax_number": "315-452-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAVILYANSKY",
        "first_name": "SERGEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "204742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01707515",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.