Active NPI
Eitel Emanuel Providence, M.D.
- Specialist
- Brooklyn, NY
National Provider Identifier
1215145552
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jan 18, 2018.
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 155818
- Practice address
- 3311 Newkirk Ave
Brooklyn, NY 11203-6108 - Phone
- (718) 284-4423
- Fax
- (718) 469-8708
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 155818 | NY | Primary |
Addresses
Primary practice location
3311 Newkirk Ave
Brooklyn, NY 11203-6108
Mailing address
3311 Newkirk Ave
Brooklyn, NY 11203-6108
Phone (718) 284-4423
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00877207 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155818 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215145552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3311 NEWKIRK AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112036108",
"telephone_number": "718-284-4423",
"fax_number": "718-469-8708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3311 NEWKIRK AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112036108",
"telephone_number": "718-284-4423",
"fax_number": "718-469-8708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVIDENCE",
"first_name": "EITEL",
"middle_name": "EMANUEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "155818",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00877207",
"state": "NY"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.