NPIMap

Organization Active NPI

Jesus Pichardo MD PC

  • Primary Care Clinic/Center
  • Ridgewood, NY
National Provider Identifier
1295902468
Registry record updated Apr 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
188066 Issued in NY
Legal business name
JESUS PICHARDO MD PC
Practice address
1623 Weirfield St
Ridgewood, NY 11385-5349
Phone
(718) 456-4600
Fax
(718) 418-3549
NPI assigned
May 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2013

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

Authorized official

Name
Dr. Jesus Manuel Pichardo, M.D.NPI 1851468433
Title
Pediatric
Phone
(718) 456-4600

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
Primary Care Clinic/Center 261QP2300X 188066 NY Primary

Addresses

Primary practice location

1623 Weirfield St
Ridgewood, NY 11385-5349

Mailing address

1623 Weirfield Street
Ridgewood, NY 11385
Phone (718) 456-4600

Other identifiers 1

IdentifierTypeStateIssuer
01463212MedicaidNY

National Provider Directory

National Provider Directory

Locations

1623 Weirfield St
Ridgewood, NY 11385
Phone (718) 456-4600

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1295902468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 WEIRFIELD STREET",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-456-4600",
            "fax_number": "718-418-3549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 WEIRFIELD ST",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855349",
            "telephone_number": "718-456-4600",
            "fax_number": "718-418-3549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESUS PICHARDO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "PICHARDO",
        "authorized_official_first_name": "JESUS",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "PEDIATRIC",
        "authorized_official_telephone_number": "718-456-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "188066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01463212",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; 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.