Active NPI
Jessica Mantzouranis, D.O.
- Pediatrics Physician
- Oyster Bay, NY
National Provider Identifier
1407905466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 239930-1
- Practice address
- 229 South St Ste 2
Oyster Bay, NY 11771-2999 - Phone
- (516) 922-3131
- Fax
- (516) 922-5218
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 239930-1 | NY | Primary |
Addresses
Primary practice location
229 South St Ste 2
Oyster Bay, NY 11771-2999
Mailing address
229 South St Ste 2
Oyster Bay, NY 11771-2999
Phone (516) 922-3131
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 239930-1 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Hyde Park Pediatrics | Pediatrics | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Organizations & group practices 1
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.
-
- Pediatrics Physician
- New Hyde Park, NY
- NPI 1720350119
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1407905466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 SOUTH ST STE 2",
"city": "OYSTER BAY",
"state": "NY",
"postal_code": "117712999",
"telephone_number": "516-922-3131",
"fax_number": "516-922-5218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 SOUTH ST STE 2",
"city": "OYSTER BAY",
"state": "NY",
"postal_code": "117712999",
"telephone_number": "516-922-3131",
"fax_number": "516-922-5218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTZOURANIS",
"first_name": "JESSICA",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2021-08-31",
"certification_date": "2021-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "239930-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oyster Bay, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.