NPIMap

Individual provider Active NPI

Andrea E Nomberg, MD

  • Family Medicine Physician
  • Ronkonkoma, NY
National Provider Identifier
1336223445
Registry record updated May 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
198213 Issued in NY
Practice address
709 Hawkins Ave
Ronkonkoma, NY 11779-2293
Phone
(631) 588-0880
Fax
(631) 588-0391
NPI assigned
Oct 25, 2006
Last updated
May 25, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 198213 NY Primary

Addresses

Primary practice location

709 Hawkins Ave
Ronkonkoma, NY 11779-2293

Mailing address

709 Hawkins Ave
Ronkonkoma, NY 11779-2293
Phone (631) 588-0880

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
I20040107000086 NY Practitioner - General Practice 4385543511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Albany Medical College of Union University, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Andrea E Nomberg Physician PCGroup PAC ID 5698000123, 2 clinicians

Practice addresses (Care Compare)

622 Hawkins Ave
Ronkonkoma, NY 11779-2374
Phone (631) 583-3333

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Andrea E Nomberg Physician PC Family Medicine CurrentSince Aug 1, 2019 Accepting new patients
Vytaliz Medical CurrentSince Jan 1, 2021 Accepting new patients
CHS Physician Partners, P.C Past Accepting new patients
Theralympic Speech Therapy PLLC PastSince Jul 21, 2019 Accepting new patients
Rakesh Sharma Physician PC Past Accepting new patients

Locations

3 E Evergreen Rd
Ste 1017
New City, NY 10956
Phone (201) 565-2533

622 Hawkins Ave
Ronkonkoma, NY 11779
Phone (631) 240-3579

709 Hawkins Ave
Ronkonkoma, NY 11779
Phone (631) 427-3300

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JEEGDD/Endpoint/JEEGDD

Organizations & group practices 5

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

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306281600000",
    "number": "1336223445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 HAWKINS AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117792293",
            "telephone_number": "631-588-0880",
            "fax_number": "631-588-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HAWKINS AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117792293",
            "telephone_number": "631-588-0880",
            "fax_number": "631-588-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOMBERG",
        "first_name": "ANDREA",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2011-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "198213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

Verify at the official NPI Registry.