NPIMap

Individual provider Active NPI

Daniil Niyazov, MD

  • Internal Medicine Physician
  • Delmar, NY
National Provider Identifier
1225457039
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
288680 Issued in NY
Practice address
250 Delaware Ave Ste 100
Delmar, NY 12054-1402
Phone
(518) 439-8077
Fax
(518) 439-8070
NPI assigned
Apr 9, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 63498 NY
Internal Medicine Physician 207R00000X 288680 NY Primary

Addresses

Primary practice location

250 Delaware Ave Ste 100
Delmar, NY 12054-1402

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other identifiers 1

IdentifierTypeStateIssuer
04823314MedicaidNY

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
I20170628000261 NY Practitioner - Internal Medicine 0648549022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Select PT, OT and SLP Rehabilitation Ny, PLLCGroup PAC ID 3870986656, 261 clinicians
Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

125 Harry Howard Ave
Hudson, NY 12534-1601
Phone (800) 479-7695

250 Delaware Ave
Suite 100
Delmar, NY 12054-1402
Phone (518) 783-3110

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
288680NYMDInternal Medicine Physician
63498NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PLLC Internal Medicine CurrentSince Aug 1, 2017 Accepting new patients
Community Care Physicians, PC Internal Medicine Past Accepting new patients

Locations

250 Delaware Ave
Ste 100
Delmar, NY 12054
Phone (518) 439-8077

6 Wellness Way
Ste 201
Latham, NY 12110
Phone (518) 237-7363

711 Troy Schenectady Rd
Ste 203
Latham, NY 12110
Phone (518) 782-3742

711 Troy Schenectady Rd
Ste 210
Latham, NY 12110

Interoperability endpoints

  • Direct secure messaging: daniilniyazov@ccp.allscriptsdirect.net

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1225457039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 DELAWARE AVE STE 100",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120541402",
            "telephone_number": "518-439-8077",
            "fax_number": "518-439-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIYAZOV",
        "first_name": "DANIIL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "63498",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "288680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04823314",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Delmar, NY

Sources for this page

Verify at the official NPI Registry.