Individual provider Active NPI

Mark Christian Manansala Estrellado, M.D.

  • Emergency Medicine Physician
  • Bronx, NY
National Provider Identifier
1336584457
Registry record updated Jan 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
288204 Issued in NY
Practice address
1400 Pelham Pkwy S
Building 6//Suite B125
Bronx, NY 10461-1138
Phone
(718) 918-5820
NPI assigned
May 2, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 288204 NY
Emergency Medicine Physician 207P00000X 288204 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1400 Pelham Pkwy S
Building 6//Suite B125
Bronx, NY 10461-1138

Mailing address

1400 Pelham Pkwy S
Building 6//Suite B125
Bronx, NY 10461-1138

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170831000325 NY Practitioner - Emergency Medicine 7517230204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
State University of New York Downstate Medical Center, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divinity Medical Services PLLCGroup PAC ID 5193030245, 92 clinicians

Practice addresses (Care Compare)

3379 Crompond Rd
Yorktown Heights, NY 10598-3605
Phone (914) 930-5550

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Divinity Medical Services PLLC CurrentSince Oct 13, 2022 Accepting new patients
Jacobi Medical Center Ed Past Accepting new patients

Locations

21304 Northern Blvd
Bayside, NY 11361
Phone (929) 744-1197

2128 Rockaway Pkwy
Brooklyn, NY 11236
Phone (718) 272-3300

3379 Crompond Rd
Yorktown Hts, NY 10598
Phone (914) 245-1111

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767484800000",
    "number": "1336584457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "address_2": "BUILDING 6//SUITE B125",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S",
            "address_2": "BUILDING 6//SUITE B125",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611138",
            "telephone_number": "718-918-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESTRELLADO",
        "first_name": "MARK CHRISTIAN",
        "middle_name": "MANANSALA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-02",
        "last_updated": "2026-01-04",
        "certification_date": "2026-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "288204",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "288204",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.