Community Internal Medicine Assoc, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

198043 Issued in NY

Legal business name

COMMUNITY INTERNAL MEDICINE ASSOC, PC

Practice address

9777 Queens Blvd
9TH FL Ste 900
Rego Park, NY 11374-3317

Phone

(212) 255-2333

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marissa Santos, MDNPI 1659332377

Title

Coowner

Phone

(212) 255-2333

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marissa T. Santos, M.D.

  • Internal Medicine Physician
  • Rego Park, NY
  • NPI 1659332377
  NPD (past) Authorized official
• Lisa Kirschbaum, MD

  • Internal Medicine Physician
  • Lake Success, NY
  • NPI 1184651507
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285759217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9777 QUEENS BLVD",
            "address_2": "9TH FL STE 900",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9777 QUEENS BLVD",
            "address_2": "9TH FL STE 900",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743317",
            "telephone_number": "212-255-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY INTERNAL MEDICINE ASSOC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANTOS",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "COOWNER",
        "authorized_official_telephone_number": "212-255-2333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "198043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5816203",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.