Glendale Family Medicine,PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

168147 Issued in NY

Legal business name

GLENDALE FAMILY MEDICINE,PC

Practice address

7801 Myrtle Ave
Glendale, NY 11385-7439

Phone

(718) 386-8300

Fax

(718) 386-0437

NPI assigned

Jun 12, 2007

Organization subpart

No

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

Authorized official

Name

Wayne Sebastiano, MDNPI 1841238722

Title

Owner

Phone

(718) 386-8300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Glendale Family Medicine, PC

  • Urgent Care Clinic/Center
  • Glendale, NY
  • NPI 1275978967
  NPPES parent name
• Glendale Family Medicine, PC

  • Primary Care Clinic/Center
  • Baldwin, NY
  • NPI 1528735453
  NPPES parent name

Practitioners 8

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

• Wayne R Sebastiano, M.D.

  • Family Medicine Physician
  • Glendale, NY
  • NPI 1841238722
  Medicare reassignment Authorized official
• Shannon Paige Batt, PA-C

  • Physician Assistant
  • Massapequa, NY
  • NPI 1497304778
  Medicare reassignment
• Michelle Berkovski, PAC

  • Physician Assistant
  • Elmhurst, NY
  • NPI 1598439432
  Medicare reassignment
• Danielle Marie Dono, PA-C

  • Physician Assistant
  • Baldwin, NY
  • NPI 1952072704
  Medicare reassignment
• Shannon Leary, PA-C

  • Physician Assistant
  • Glendale, NY
  • NPI 1477227338
  Medicare reassignment
• Andrew Marcos, PAC

  • Medical Physician Assistant
  • Baldwin, NY
  • NPI 1689071672
  Medicare reassignment
• Diane M Bruessow, PA-C

  • Medical Physician Assistant
  • Florence, MA
  • NPI 1063552487

  NY

  Medicare reassignment
• David NMN Kao, P.A.-C.

  • Medical Physician Assistant
  • Paris, TN
  • NPI 1699381616

  NY

  Medicare reassignment

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448409600000",
    "number": "1346444734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7801 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857439",
            "telephone_number": "718-386-8300",
            "fax_number": "718-386-0437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857439",
            "telephone_number": "718-386-8300",
            "fax_number": "718-386-0437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE FAMILY MEDICINE,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2015-11-25",
        "status": "A",
        "authorized_official_last_name": "SEBASTIANO",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-386-8300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "168147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Glendale, NY
• Providers in Glendale, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.