NPIMap

Organization Active NPI

Greenwich Village Medical Group, PC

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1225249204
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GREENWICH VILLAGE MEDICAL GROUP, PC
Practice address
41 E 11TH St FL 9
New York, NY 10003-4602
Phone
(212) 604-8026
Fax
(212) 604-7627
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. F. Russell Kellogg, M.D.
Title
President
Phone
(212) 604-8026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

41 E 11TH St FL 9
New York, NY 10003-4602

Mailing address

41 E 11TH St FL 9
New York, NY 10003-4602
Phone (212) 604-8026

Other identifiers 1

IdentifierTypeStateIssuer
00588427MedicaidNY

National Provider Directory

National Provider Directory

Locations

41 E 11th St
Fl 9
New York, NY 10003
Phone (212) 604-8073

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225249204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E 11TH ST FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034602",
            "telephone_number": "212-604-8026",
            "fax_number": "212-604-7627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 E 11TH ST FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034602",
            "telephone_number": "212-604-8026",
            "fax_number": "212-604-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWICH VILLAGE MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "F.",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-604-8026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00588427",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.