Organization Active NPI

Mag Medical, PC

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1215008040
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
196595 Issued in NY
Legal business name
MAG MEDICAL, PC
Practice address
2379 65TH St
Brooklyn, NY 11204-4045
Phone
(718) 375-0392
Fax
(718) 375-4324
NPI assigned
Nov 13, 2006
Last updated
Nov 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Authorized official

Name
Dr. Alexander Merson, MDNPI 1194755983
Title
Owner
Phone
(718) 375-0392

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 196595 NY Primary

Addresses

Primary practice location

2379 65TH St
Brooklyn, NY 11204-4045

Mailing address

27 Beaumont St
Brooklyn, NY 11235-4103
Phone (718) 375-0392

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001736 NY Part B Supplier - Clinic/Group Practice 0941191456 Receives reassigned benefits from 4 practitioners
Practice locations: Brooklyn, 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
33D0931079Mag Medical PC2379 65TH Street, Brooklyn, NY 11204Certificate of waiverApr 5, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257206400000",
    "number": "1215008040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 BEAUMONT ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112354103",
            "telephone_number": "718-375-0392",
            "fax_number": "718-375-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2379 65TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112044045",
            "telephone_number": "718-375-0392",
            "fax_number": "718-375-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAG MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2009-11-03",
        "status": "A",
        "authorized_official_last_name": "MERSON",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-375-0392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; 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.