Active NPI
Gonzalo Alberto Sepulveda Moreno, MD
- Ophthalmology Physician
- New York, NY
National Provider Identifier
1376826396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- P81908
- Practice address
- 635 West 165TH Street
New York, NY 10032 - Phone
- (212) 305-9535
- NPI assigned
- Sep 26, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | P81908 | NY | Primary |
Addresses
Primary practice location
635 West 165TH Street
New York, NY 10032
Mailing address
33 West End Avenue
Apt 17 a
New York, NY 10023
Phone (917) 855-0591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P81908 | NY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1376826396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 WEST END AVENUE",
"address_2": "APT 17 A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10023",
"telephone_number": "917-855-0591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 WEST 165TH STREET",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10032",
"telephone_number": "212-305-9535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEPULVEDA MORENO",
"first_name": "GONZALO",
"middle_name": "ALBERTO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-26",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NY",
"license": "P81908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.