Individual provider Active NPI

Michael T Imperato, M.D.

  • Emergency Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1194791665
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
171119-1 Issued in NY
Practice address
Suny Stony Brook Emergency Dept
HSC, Level 4, Room 080
Stony Brook, NY 11794-8350
Phone
(631) 444-2478
Fax
(631) 444-3919
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 171119-1 NY Primary

Addresses

Primary practice location

Suny Stony Brook Emergency Dept
HSC, Level 4, Room 080
Stony Brook, NY 11794-8350

Mailing address

PO Box 826207
Philadelphia, PA 19182-6207
Phone (800) 377-8721

Other identifiers 2

IdentifierTypeStateIssuer
01385419MedicaidNY
1653Q1OtherNYBCBS

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
I20051019000289 NY Practitioner - Emergency Medicine 6406872472 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
171119-1NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Jan 17, 2016 Accepting new patients
North Shore-Lij Medical PC Emergency Medicine CurrentSince Jan 17, 2016 Accepting new patients
Island Emergency Medical Services, P.C. Emergency Medicine Past Accepting new patients

Locations

4295 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 520-2250

300 Community Dr
Plandome, NY 11030

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

972 Brush Hollow Rd
Westbury, NY 11590

Organizations & group practices 3

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194791665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 826207",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191826207",
            "telephone_number": "800-377-8721",
            "fax_number": "304-523-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY STONY BROOK EMERGENCY DEPT",
            "address_2": "HSC, LEVEL 4, ROOM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-2478",
            "fax_number": "631-444-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMPERATO",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "171119-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01385419",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1653Q1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.