Individual provider Active NPI

Adi Davidov, MD

  • Obstetrics & Gynecology Physician
  • Staten Island, NY
National Provider Identifier
1356324677
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
212520 Issued in NY
Practice address
440 Seaview Ave
Staten Island, NY 10305-3401
Phone
(718) 226-6550
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 212520 NY Primary
Internal Medicine Physician 207R00000X 212520 NY

Addresses

Primary practice location

440 Seaview Ave
Staten Island, NY 10305-3401

Mailing address

1 Edgewater St
6TH FL. Payer Relations
Staten Island, NY 10305-4900
Phone (718) 226-1008

Other identifiers 1

IdentifierTypeStateIssuer
02568707MedicaidNY

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
I20040806000883 NY Practitioner - Obstetrics/Gynecology 5193797504 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

440 Seaview Ave
Staten Island, NY 10305-3401
Phone (718) 226-6791

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantagecare Physicians PC CurrentSince Jan 2, 2020 Accepting new patients
Sun River Health Inc. CurrentSince Nov 11, 2019 Accepting new patients
Physicians of University Hospital, PC Internal Medicine CurrentSince Dec 1, 2009 Accepting new patients
Sun River Health Inc Current Accepting new patients
Physicians of University Hospital, PC CurrentSince Dec 1, 2009 Accepting new patients
Advantagecare Physicians PC Internal Medicine CurrentSince Jan 2, 2020 Accepting new patients
North Shore-Lij Medical PC Internal Medicine CurrentSince May 1, 2019 Accepting new patients
Staten Island University Hospital Past Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

803 Sterling Pl
Brooklyn, NY 11216
Phone (718) 613-1700

300 Community Dr
Plandome, NY 11030

440 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-6550

1050 Clove Rd
Staten Island, NY 10301
Phone (718) 816-6440

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

4771 Hylan Blvd
Staten Island, NY 10312
Phone (718) 948-8200

1 Edgewater St
Fl 6
Staten Island, NY 10305
Phone (718) 226-1047

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

57 Bay St
Staten Island, NY 10301
Phone (718) 226-3200

401 Seaview Ave
Lowr
Staten Island, NY 10305
Phone (718) 226-6186

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4
  • Direct secure messaging: adavidov23619@northwell.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1356324677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EDGEWATER ST",
            "address_2": "6TH FL. PAYER RELATIONS",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054900",
            "telephone_number": "718-226-1008",
            "fax_number": "718-226-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053401",
            "telephone_number": "718-226-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDOV",
        "first_name": "ADI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "212520",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "212520",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02568707",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.