Active NPI
Fifth Avenue Surgical Specialists PLLC
- Surgery Physician
- Greenwich, CT
National Provider Identifier
1235853649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- FIFTH AVENUE SURGICAL SPECIALISTS PLLC
- Practice address
- 75 Holly Hill LN Ste 201
Greenwich, CT 06830-2912 - Phone
- (201) 357-8888
- Fax
- (216) 482-8082
- NPI assigned
- Sep 29, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paul A Tsoukalas
- Title
- Exec Director
- Phone
- (917) 250-4958
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
75 Holly Hill LN Ste 201
Greenwich, CT 06830-2912
Mailing address
75 Holly Hill LN Ste 201
Greenwich, CT 06830-2912
Phone (201) 357-8888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231212002016 | CT | Part B Supplier - Clinic/Group Practice | 3678921483 |
Receives reassigned benefits from 1 practitioner Practice locations: Greenwich, CT |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Fifth Avenue Surgical Specialists PLLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Surgery Physician
- Oyster Bay, NY
- NPI 1134855901
-
- Surgery Physician
- Teaneck, NJ
- NPI 1932987740
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Specialist
- New York, NY
- NPI 1558372904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664409600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695254400000",
"number": "1235853649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 HOLLY HILL LN STE 201",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068302912",
"telephone_number": "201-357-8888",
"fax_number": "216-482-8082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 HOLLY HILL LN STE 201",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068302912",
"telephone_number": "201-357-8888",
"fax_number": "216-482-8082"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIFTH AVENUE SURGICAL SPECIALISTS PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-29",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A",
"authorized_official_last_name": "TSOUKALAS",
"authorized_official_first_name": "PAUL",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "EXEC DIRECTOR",
"authorized_official_telephone_number": "917-250-4958"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.