Individual provider Active NPI

Jay M Nfonoyim, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Staten Island, NY
National Provider Identifier
1386756906
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
182840 Issued in NY
Practice address
355 Bard Ave
Medicine/ Critical Care
Staten Island, NY 10310-1664
Phone
(718) 818-4452
Fax
(718) 818-3225
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 182840 NY Primary

Addresses

Primary practice location

355 Bard Ave
Medicine/ Critical Care
Staten Island, NY 10310-1664

Mailing address

15 Maguire CT # B1
Staten Island, NY 10309-2819
Phone (718) 370-9778

Other identifiers 1

IdentifierTypeStateIssuer
01355146MedicaidNY

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
I20070801000277 NY Practitioner - Critical Care (Intensivists) 4183715428 Reassigns benefits to 1 organization
Practice locations: Staten Island, NY

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amboy Medical Practice PCGroup PAC ID 2860538170, 171 clinicians

Practice addresses (Care Compare)

355 Bard Ave
Staten Island, NY 10310-1664

4434 Amboy Rd
Staten Island, NY 10312-3845
Phone (718) 984-9658

Hospital & facility affiliations

  • Richmond University Medical Center Hospital, Staten Island, NY, CCN 330028

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
182840NYMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amboy Medical Practice PC CurrentSince Oct 1, 2009 Accepting new patients
Amboy Medical Practice PC CurrentSince Oct 1, 2009 Accepting new patients
Richmond University Medical Center Past Accepting new patients
Richmond Medical Center Past Accepting new patients

Locations

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

275 Castleton Ave
Staten Island, NY 10301
Phone (718) 447-2829

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

2177 Victory Blvd
Staten Island, NY 10314
Phone (718) 370-3730

Networks

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

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213574400000",
    "number": "1386756906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MAGUIRE CT # B1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103092819",
            "telephone_number": "718-370-9778",
            "fax_number": "718-370-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "address_2": "MEDICINE/ CRITICAL CARE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-4452",
            "fax_number": "718-818-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NFONOYIM",
        "first_name": "JAY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "182840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01355146",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.