Four Corners Medical PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FOUR CORNERS MEDICAL PC

Practice address

11622 Metropolitan Ave
Richmond Hill, NY 11418-1017

Phone

(347) 466-3605

Fax

(347) 317-7895

NPI assigned

Jun 12, 2022

Organization subpart

No

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

Authorized official

Name

Jean-Yves Dastain, MDNPI 1417213299

Title

Owner

Phone

(347) 466-3605

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

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

• Kashyar Khodabakhsh, M.D.

  • Neurology Physician
  • New York, NY
  • NPI 1073788667
  Medicare reassignment Care Compare group NPD
• Salvatore Trazzera, MD

  • Cardiovascular Disease Physician
  • North Babylon, NY
  • NPI 1568469757
  Medicare reassignment Care Compare group NPD
• Jean-Yves Dastain, M.D.

  • Procedural Dermatology Physician
  • Naples, FL
  • NPI 1417213299

  Internal Medicine, NY

  Medicare reassignment NPD Authorized official
• Paul M Madaj, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Springfield, MA
  • NPI 1679994396

  Internal Medicine, NY

  Medicare reassignment NPD

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

{
    "created_epoch": "1654992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1356071526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7907 METROPOLITAN AVE",
            "city": "MIDDLE VILLAGE",
            "state": "NY",
            "postal_code": "113792930",
            "telephone_number": "347-466-3605",
            "fax_number": "347-317-7895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11622 METROPOLITAN AVE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114181017",
            "telephone_number": "347-466-3605",
            "fax_number": "347-317-7895"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7907 Metropolitan Ave",
            "address_purpose": "LOCATION",
            "city": "Middle Village",
            "state": "NY",
            "postal_code": "113792930",
            "country_code": "US",
            "telephone_number": "347-466-3605",
            "fax_number": "347-317-7895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUR CORNERS MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-12",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "DASTAIN",
        "authorized_official_first_name": "JEAN-YVES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-466-3605",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mbella Fidelis Ndumbe Mbome, MD
• First Health Medical P.C.
• Julia Elizabeth Fleri
• Kristoffer Flores, PHYSICIAN ASSISTANT
• Sonia Forbes, OT
• Karen Andrea Francis
• Frank J Ross MD PC
• Rebecca Rivka Frank
• Amanda Kristine Fravola, RD CDN
• Gloria Okaonye Fredrick II, RN

• Internal Medicine Physician in Richmond Hill, NY
• Providers in Richmond Hill, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.