NPIMap

Organization Active NPI

KJ Medical Practice PC

  • Pediatrics Physician
  • Monroe, NY
National Provider Identifier
1366739088
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
232596 Issued in NY
Legal business name
KJ MEDICAL PRACTICE PC
Practice address
14 Raywood Dr
Monroe, NY 10950-2414
Phone
(845) 782-4000
Fax
(845) 782-6007
NPI assigned
Jul 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Authorized official

Name
Dr. Seth Kurtz, MDNPI 1023113453
Title
President
Phone
(845) 782-4000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X 232596 NY
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 232596 NY Primary

Addresses

Primary practice location

14 Raywood Dr
Monroe, NY 10950-2414

Mailing address

12 Deerwood Rd
Spring Valley, NY 10977-1001

Other names 1

  • Elite Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130311000018 NY Part B Supplier - Clinic/Group Practice 9032364492 Receives reassigned benefits from 10 practitioners
Practice locations: Spring Valley, NY

National Provider Directory

National Provider Directory

Locations

14 Raywood Dr
Monroe, NY 10950
Phone (845) 232-1353

745 State Route 17M
Ste 104
Monroe, NY 10950
Phone (845) 561-8060

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1366739088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 DEERWOOD RD",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109771001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 RAYWOOD DR",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109502414",
            "telephone_number": "845-782-4000",
            "fax_number": "845-782-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KJ MEDICAL PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "KURTZ",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-782-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "232596",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "232596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.