NPIMap

Individual provider Active NPI

Mary J Kollakuzhiyil, M.D.

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1366518052
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
239114 Issued in NY
Practice address
535 E 70TH St
New York, NY 10021-4872
Phone
(212) 606-1620
Fax
(212) 606-1605
NPI assigned
Nov 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 239114 NY Primary

Addresses

Primary practice location

535 E 70TH St
New York, NY 10021-4872

Mailing address

535 E 70TH St
New York, NY 10021-4872
Phone (212) 606-1620

Other identifiers 1

IdentifierTypeStateIssuer
239114OtherNYNYS LICENSE NUMBER

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Direct
Direct Messaging Address mkollakuzhiyil9401@direct.HSS.edu Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/ Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070321000149 NY Practitioner - Internal Medicine 7416050935 Reassigns benefits to 1 organization
I20200624001509 NJ Practitioner - Internal Medicine 7416050935 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York Society for the Relief of Ruptured and Crippled MaintainingGroup PAC ID 4789818204, shared by 2 NPIs, 115 clinicians

Practice addresses (Care Compare)

140 E Ridgewood Ave
Suite 175 S
Paramus, NJ 07652-3917
Phone (201) 599-8000

535 E 70TH St
New York, NY 10021-4823
Phone (212) 774-7598

Hospital & facility affiliations

  • Hospital for Special Surgery Hospital, New York, NY, CCN 330270

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Mar 1, 2015 Accepting new patients
New York Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Mar 1, 2015 Accepting new patients
New York Society for the Relief of Ruptured & Crippled Maintaining Past Accepting new patients
F a Cordasco MD PLLC Past Accepting new patients
New York Society for the Relief of the Ruptured and Crippled Maintaini Past Accepting new patients

Locations

140 E Ridgewood Ave
Ste 175
Paramus, NJ 07652
Phone (201) 599-8000

535 E 70th St
Fl 2
New York, NY 10021
Phone (212) 606-1213

541 E 71st St
New York, NY 10021
Phone (212) 606-1136

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mkollakuzhiyil9401@direct.hss.edu

Organizations & group practices 5

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 10

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": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1366518052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214872",
            "telephone_number": "212-606-1620",
            "fax_number": "212-606-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214872",
            "telephone_number": "212-606-1620",
            "fax_number": "212-606-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLAKUZHIYIL",
        "first_name": "MARY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "239114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE NUMBER",
            "identifier": "239114",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkollakuzhiyil9401@direct.HSS.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.