NPIMap

Organization Active NPI

25A Medical

  • Pulmonary Disease Physician
  • Central Islip, NY
National Provider Identifier
1225748494
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
25A MEDICAL
Practice address
100 W Suffolk Avenue Unit G
Central Islip, NY 11722-2430
Phone
(631) 993-5400
Fax
(518) 712-1634
NPI assigned
Nov 29, 2022
Last updated
Nov 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Authorized official

Name
Anthony TheodorisNPI 1578675971
Title
Owner
Phone
(631) 993-5400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

100 W Suffolk Avenue Unit G
Central Islip, NY 11722-2430

Mailing address

100 W Suffolk Avenue Unit G
Central Islip, NY 11722-2430
Phone (631) 993-5400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1225748494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W SUFFOLK AVENUE UNIT G",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117222430",
            "telephone_number": "631-993-5400",
            "fax_number": "518-712-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W SUFFOLK AVENUE UNIT G",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117222430",
            "telephone_number": "631-993-5400",
            "fax_number": "518-712-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "25A MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "THEODORIS",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-993-5400"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Central Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.