NPIMap

Organization Active NPI

Island Medical Specialists, P.L.L.C.

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1407844160
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ISLAND MEDICAL SPECIALISTS, P.L.L.C.
Practice address
2627 Hylan Blvd Ste C
Staten Island, NY 10306-4344
Phone
(718) 351-1136
Fax
(718) 667-9711
NPI assigned
Oct 7, 2005
Last updated
Dec 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Authorized official

Name
Lori Guterman
Title
Credentialing Coordinator
Phone
(718) 876-6220

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X NY Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X NY

Addresses

Primary practice location

2627 Hylan Blvd Ste C
Staten Island, NY 10306-4344

Mailing address

2627 Hylan Blvd Ste C
Staten Island, NY 10306-4344
Phone (718) 351-1136

Other practice location 1

501 Seaview Ave Ste 100
Staten Island, NY 10305-3400
Phone (718) 683-3955

Other identifiers 1

IdentifierTypeStateIssuer
02679945MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040712000977 NY Part B Supplier - Clinic/Group Practice 9436137817 Receives reassigned benefits from 4 practitioners
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Locations

501 Seaview Ave
Staten Island, NY 10305
Phone (718) 667-4700

97 New Dorp Ln
Ste A
Staten Island, NY 10306

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1407844160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 HYLAN BLVD STE C",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064344",
            "telephone_number": "718-351-1136",
            "fax_number": "718-667-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 HYLAN BLVD STE C",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064344",
            "telephone_number": "718-351-1136",
            "fax_number": "718-667-9711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Seaview Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103053400",
            "country_code": "US",
            "telephone_number": "718-683-3955",
            "fax_number": "718-667-9711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ISLAND MEDICAL SPECIALISTS, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-07",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "GUTERMAN",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "718-876-6220"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02679945",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; 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.