NPIMap

Individual provider Active NPI

Robert Mormando, D.O.

  • Internal Medicine Physician
  • Port Jefferson Station, NY
National Provider Identifier
1306816129
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
200407 Issued in NY
Practice address
410 Hallock Ave
Port Jefferson Station, NY 11776-1232
Phone
(631) 642-1100
Fax
(631) 642-1190
NPI assigned
Jan 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 200407 NY Primary

Addresses

Primary practice location

410 Hallock Ave
Port Jefferson Station, NY 11776-1232

Mailing address

410 Hallock Ave
Port Jefferson Station, NY 11776-1232
Phone (631) 642-1100

Other identifiers 1

IdentifierTypeStateIssuer
200407OtherNYLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040416000770 NY Practitioner - Internal Medicine 8729073036 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

90 S Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

Hospital & facility affiliations

  • Tender Loving Care, an Amedisys Company Home health agency, Medford, NY, CCN 337260
  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
  • Constellation Home Care Home health agency, Syosset, NY, CCN 337447
  • Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
  • Good Shepherd Hospice Hospice, Farmingdale, NY, CCN 331544
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation Internal Medicine CurrentSince Nov 1, 2019 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Nov 1, 2019 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

205 N Belle Mead Rd
Setauket, NY 11733
Phone (631) 444-1660

676 County Road 39A
Southampton, NY 11968
Phone (631) 283-2070

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Philadelphia, PA 19195

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306816129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 HALLOCK AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761232",
            "telephone_number": "631-642-1100",
            "fax_number": "631-642-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 HALLOCK AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761232",
            "telephone_number": "631-642-1100",
            "fax_number": "631-642-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORMANDO",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "200407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "200407",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.