NPIMap

Organization Active NPI

Andrea E Nomberg Physician PC

  • Family Medicine Physician
  • Ronkonkoma, NY
National Provider Identifier
1295394120
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ANDREA E NOMBERG PHYSICIAN PC
Practice address
622 Hawkins Ave
Ronkonkoma, NY 11779-2374
Phone
(631) 583-3333
NPI assigned
Jun 13, 2019
Last updated
Feb 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Andrea Nomberg, MDNPI 1336223445
Title
Owner
Phone
(631) 583-3333

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

622 Hawkins Ave
Ronkonkoma, NY 11779-2374

Mailing address

1 Venezia CT
Deer Park, NY 11729-1508

Other identifiers 1

IdentifierTypeStateIssuer
102723OtherNYLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190705000455 NY Part B Supplier - Clinic/Group Practice 5698000123 Receives reassigned benefits from 2 practitioners
Practice locations: Ronkonkoma, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2205780Andrea E Nomberg MD Physician PC622 Hawkins Ave, Ronkonkoma, NY 11779Certificate of waiverDec 15, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 71

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.

View all 71

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1295394120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VENEZIA CT",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 HAWKINS AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117792374",
            "telephone_number": "631-583-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREA E NOMBERG PHYSICIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-13",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "NOMBERG",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-583-3333",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "102723",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.