NPIMap

Organization Active NPI

Ji Medical PC

Doing business as Kalon Dermatology

  • Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1366035248
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JI MEDICAL PC
Doing business as
Kalon Dermatology
Practice address
2792 Ocean Ave FL 2
Brooklyn, NY 11229-4731
Phone
(917) 855-0007
NPI assigned
Feb 11, 2021
Last updated
Jun 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Authorized official

Name
Joseph IwanickiNPI 1225105513
Title
Practice Owner
Phone
(917) 855-0007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2792 Ocean Ave FL 2
Brooklyn, NY 11229-4731

Mailing address

2792 Ocean Ave FL 2
Brooklyn, NY 11229-4731

Other names 1

  • Kalon Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210618000064 NY Part B Supplier - Clinic/Group Practice 0749680395 Receives reassigned benefits from 10 practitioners
Practice locations: Brooklyn, NY; Merrick, NY

National Provider Directory

National Provider Directory

Locations

1850 Merrick Rd
Merrick, NY 11566
Phone (718) 332-8633

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1366035248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2792 OCEAN AVE FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112294731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2792 OCEAN AVE FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112294731",
            "telephone_number": "917-855-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JI MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "IWANICKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "917-855-0007"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kalon Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.