Active NPI
Debra H Etelson, MD
- Pediatrics Physician
- New Rochelle, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 207127
- Practice address
- 145 Huguenot St
Suite 200
New Rochelle, NY 10801-5200 - Phone
- (914) 235-1400
- Fax
- (914) 235-1534
- NPI assigned
- Aug 18, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 207127 | NY | Primary |
Addresses
Primary practice location
145 Huguenot St
Suite 200
New Rochelle, NY 10801-5200
Mailing address
145 Huguenot St
Suite 200
New Rochelle, NY 10801-5200
Phone (914) 235-1400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01856633 | Medicaid | NY |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 207127 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boston Childrens Health Physicians LLP | Current | Accepting new patients | |
| White Plains Physician Services PC | Pediatrics | Current | Accepting new patients |
| Boston Children'S Health Physicians, LLP | Pediatrics | Current | Accepting new patients |
| Pediatric Associates of Southern Westchester P C | Pediatrics | Past | Accepting new patients |
Locations
19 Bradhurst Ave
Hawthorne, NY 10532
Phone (914) 493-7235
19 Bradhurst Ave
Ste 800
Hawthorne, NY 10532
Phone (914) 593-8850
22 Saw Mill River Rd
Ste 2
Hawthorne, NY 10532
Phone (914) 593-1606
185 Kisco Ave
Ste 300
Mount Kisco, NY 10549
Phone (914) 242-2020
145 Huguenot St
Ste 200
New Rochelle, NY 10801
Phone (914) 235-1400
259 Heathcote Rd
Scarsdale, NY 10583
Phone 9147238100106
325 Route 100
Somers, NY 10589
Phone (914) 597-2890
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 4
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.
-
- Pediatrics Physician
- Hawthorne, NY
- NPI 1467454967
-
- Internal Medicine Physician
- White Plains, NY
- NPI 1124502687
Pediatrics
-
- Clinical Medical Laboratory
- Sleepy Hollow, NY
- NPI 1588651079
-
- Pediatrics Physician
- New Rochelle, NY
- NPI 1205922473
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364947200000",
"number": "1215929054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 HUGUENOT ST",
"address_2": "SUITE 200",
"city": "NEW ROCHELLE",
"state": "NY",
"postal_code": "108015200",
"telephone_number": "914-235-1400",
"fax_number": "914-235-1534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 HUGUENOT ST",
"address_2": "SUITE 200",
"city": "NEW ROCHELLE",
"state": "NY",
"postal_code": "108015200",
"telephone_number": "914-235-1400",
"fax_number": "914-235-1534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETELSON",
"first_name": "DEBRA",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-18",
"last_updated": "2013-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "207127",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01856633",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New Rochelle, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.