Individual provider Active NPI

Patricia Victoria Mena Rosario, M.D.

  • Pediatrics Physician
  • Glen Cove, NY
National Provider Identifier
1255774451
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
285357-1 Issued in NY
Practice address
10 Medical PLZ Ste 301
Glen Cove, NY 11542-2101
Phone
(516) 676-7116
NPI assigned
Apr 8, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 285357-1 NY Primary

Addresses

Primary practice location

10 Medical PLZ Ste 301
Glen Cove, NY 11542-2101

Mailing address

813 Station Way
Huntington Station, NY 11746-1970
Phone (516) 949-6128

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161227001742 NY Practitioner - Pediatric Medicine 0648551002 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
285357-1NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Feb 17, 2020 Accepting new patients
North Shore - Lij Medical PC CurrentSince Feb 17, 2020 Accepting new patients
John P. Sheehy,M.D.,PC PastSince Jan 19, 2020 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

1 School St
Ste 203
Glen Cove, NY 11542
Phone (516) 671-9800

300 Community Dr
Plandome, NY 11030

Networks

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

Interoperability endpoints

  • Direct secure messaging: patriciamena@nslijmedgr.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1255774451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 STATION WAY",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117461970",
            "telephone_number": "516-949-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PLZ STE 301",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422101",
            "telephone_number": "516-676-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENA ROSARIO",
        "first_name": "PATRICIA",
        "middle_name": "VICTORIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-08",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "285357-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Cove, NY

Sources for this page

Verify at the official NPI Registry.