Organization Active NPI

City Medical Physician PC

  • Ophthalmology Physician
  • Bronx, NY
National Provider Identifier
1265299044
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
CITY MEDICAL PHYSICIAN PC
Practice address
417 E 138TH St
Bronx, NY 10454-3004
Phone
(845) 359-7272
Fax
(845) 359-7388
NPI assigned
Feb 28, 2024
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Ayman MattaNPI 1841288388
Title
Owner
Phone
(845) 652-0151

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

417 E 138TH St
Bronx, NY 10454-3004

Mailing address

99 Dutch Hill Rd
Orangeburg, NY 10962-2185
Phone (845) 359-7272

Other practice location 1

99 Dutch Hill Rd
Orangeburg, NY 10962-2185
Phone (845) 359-7272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240506003416 NY Part B Supplier - Clinic/Group Practice 0244670362 Receives reassigned benefits from 4 practitioners
Practice locations: Bronx, NY; Orangeburg, NY

National Provider Directory

National Provider Directory

Locations

417 E 138th St
Bronx, NY 10454
Phone (917) 642-1035

Practitioners & affiliated clinicians

Practitioners 4

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": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1265299044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 DUTCH HILL RD",
            "city": "ORANGEBURG",
            "state": "NY",
            "postal_code": "109622185",
            "telephone_number": "845-359-7272",
            "fax_number": "845-359-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 E 138TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104543004",
            "telephone_number": "845-359-7272",
            "fax_number": "845-359-7388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 Dutch Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Orangeburg",
            "state": "NY",
            "postal_code": "109622185",
            "country_code": "US",
            "telephone_number": "845-359-7272",
            "fax_number": "845-359-7388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CITY MEDICAL PHYSICIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "AYMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-652-0151"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.

Verify at the official NPI Registry.