Individual provider Active NPI

Debra H Etelson, MD

  • Pediatrics Physician
  • New Rochelle, NY
National Provider Identifier
1215929054
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
207127 Issued in NY
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

Updated by the provider on Apr 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
01856633MedicaidNY

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
I20051208000159 NY Practitioner - Pediatric Medicine 5395766182 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
207127NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Childrens Health Physicians LLP CurrentSince Nov 1, 2018 Accepting new patients
White Plains Physician Services PC Pediatrics CurrentSince Jul 19, 2023 Accepting new patients
Boston Children'S Health Physicians, LLP Pediatrics CurrentSince Nov 1, 2018 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.