NPIMap

Individual provider Active NPI

Eliyahu Samuel Kopstick, D.O

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1225083546
Registry record updated Mar 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
235575 Issued in NY
Practice address
2315 Victory Blvd
Staten Island, NY 10314-6623
Phone
(718) 477-6900
Fax
(718) 477-7862
NPI assigned
May 24, 2006
Last updated
Mar 27, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 235575 NY Primary

Addresses

Primary practice location

2315 Victory Blvd
Staten Island, NY 10314-6623

Mailing address

2315 Victory Blvd
Staten Island, NY 10314-6623
Phone (718) 477-6900

Other identifiers 10

IdentifierTypeStateIssuer
7270822OtherNYAETNA PPO#
KE5575OtherNYATLANTIS HEALTH PLAN
235575OtherNYHIP
5C7787OtherNYHEALTHNET ID#
0145896OtherNYGHI PPO
0414219OtherNYEVERCARE
348ST1OtherNYEMPIRE BCBS
P3808101OtherNYOXFORD ID#
000000116248OtherNYGHI HMO
1466245OtherNYAETNA HMO#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070418000298 NY Practitioner - Internal Medicine 1759485790 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 8921326570, 6 clinicians

Practice addresses (Care Compare)

4982 Hylan Blvd
Staten Island, NY 10312-6399
Phone (718) 966-9226

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Internal Medicine CurrentSince Mar 1, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Staten Island Physician Practice PC Internal Medicine Past Accepting new patients

Locations

2315 Victory Blvd
Staten Island, NY 10314
Phone (718) 477-6900

4982 Hylan Blvd
Staten Island, NY 10312
Phone (718) 477-6900

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ekopstick66593@northwell.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206576000000",
    "number": "1225083546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146623",
            "telephone_number": "718-477-6900",
            "fax_number": "718-477-7862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146623",
            "telephone_number": "718-477-6900",
            "fax_number": "718-477-7862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPSTICK",
        "first_name": "ELIYAHU",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "235575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO#",
            "identifier": "7270822",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATLANTIS HEALTH PLAN",
            "identifier": "KE5575",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "235575",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET ID#",
            "identifier": "5C7787",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI PPO",
            "identifier": "0145896",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "0414219",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS",
            "identifier": "348ST1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD ID#",
            "identifier": "P3808101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI HMO",
            "identifier": "000000116248",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO#",
            "identifier": "1466245",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.