NPIMap

Individual provider Active NPI

Ida Bronfman, M.D.

  • Internal Medicine Physician
  • Flushing, NY
National Provider Identifier
1396826814
Registry record updated Mar 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
199887 Issued in NY
Practice address
4004 Bowne St
Suite 1I
Flushing, NY 11354-6143
Phone
(718) 539-3359
Fax
(718) 358-3837
NPI assigned
Oct 18, 2006
Last updated
Mar 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2015

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 199887 NY Primary

Addresses

Primary practice location

4004 Bowne St
Suite 1I
Flushing, NY 11354-6143

Mailing address

4004 Bowne St
Suite 1I
Flushing, NY 11354-6143
Phone (718) 539-3359

Other identifiers 2

IdentifierTypeStateIssuer
01580827MedicaidNY
02517393MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040507001321 NY Practitioner - Internal Medicine 4082603097 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4004 Bowne St
Suite 1
Flushing, NY 11354-6159
Phone (718) 539-3359

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
199887NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Queens - Ny Medical, P.C. Internal Medicine CurrentSince Dec 1, 2003 Accepting new patients
New York Physical Therapy Rehabilitation Services PC Past Accepting new patients

Locations

4004 Bowne St
Apt 1I
Flushing, NY 11354
Phone (718) 539-3359

4004 Bowne St
Ste 1
Flushing, NY 11354
Phone (718) 539-3359

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBGGAA/Endpoint/FBGGAA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426204800000",
    "number": "1396826814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 BOWNE ST",
            "address_2": "SUITE 1I",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546143",
            "telephone_number": "718-539-3359",
            "fax_number": "718-358-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BOWNE ST",
            "address_2": "SUITE 1I",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546143",
            "telephone_number": "718-539-3359",
            "fax_number": "718-358-3837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONFMAN",
        "first_name": "IDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2015-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "199887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01580827",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02517393",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.