Staten Island Medical Group, PLLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

4431 Issued in NY

Legal business name

STATEN ISLAND MEDICAL GROUP, PLLC

Practice address

2071 Clove Rd
Staten Island, NY 10304-1612

Phone

(718) 391-0303

NPI assigned

Jun 28, 2012

Last updated

Jun 28, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rosemarie Phillip, MD

Title

Medical Director

Phone

(201) 857-4011

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340841600000",
    "number": "1326302803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 581",
            "city": "SADDLE RIVER",
            "state": "NJ",
            "postal_code": "074580581",
            "telephone_number": "201-857-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2071 CLOVE RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103041612",
            "telephone_number": "718-391-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-28",
        "last_updated": "2012-06-28",
        "status": "A",
        "authorized_official_last_name": "PHILLIP",
        "authorized_official_first_name": "ROSEMARIE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "201-857-4011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "4431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAAASF",
            "identifier": "4431",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Ambulatory Surgical Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; 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.