Individual provider Active NPI

Joseph Illovsky, LCSW

  • Clinical Social Worker
  • Coram, NY
National Provider Identifier
1265969257
Registry record updated May 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
085408 Issued in NY
Practice address
34 Teller Ave
Coram, NY 11727-4042
Phone
(631) 449-3678
NPI assigned
May 22, 2017
Last updated
May 22, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 085408 NY Primary

Addresses

Primary practice location

34 Teller Ave
Coram, NY 11727-4042

Mailing address

34 Teller Ave
Coram, NY 11727-4042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170619001599 NY Practitioner - Clinical Social Worker 3476821398 Reassigns benefits to 1 organization
Practice locations: Port Jefferson Station, NY
I20250528001379 CA Practitioner - Clinical Social Worker 3476821398 Practice locations: Winnetka, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
State University of New York at Stony Brook, School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Winnetka, CA 91306
Phone (631) 449-3678

1050 Hallock Ave
Port Jefferson, NY 11776-1214
Phone (631) 449-3678

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085408NYMDClinical Social Worker

Networks

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495411200000",
    "number": "1265969257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 TELLER AVE",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117274042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 TELLER AVE",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117274042",
            "telephone_number": "631-449-3678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLOVSKY",
        "first_name": "JOSEPH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-22",
        "last_updated": "2017-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "085408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coram, NY

Sources for this page

Verify at the official NPI Registry.