Individual provider Active NPI

Lydia Tripolsky, M.D.

  • Pediatrics Physician
  • Staten Island, NY
National Provider Identifier
1417254160
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
258768 Issued in NY
Practice address
242 Mason Ave
Suite 1
Staten Island, NY 10305-3408
Phone
(718) 226-6221
Fax
(718) 226-6003
NPI assigned
Feb 15, 2011
Last updated
Jan 12, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 258768 NY Primary

Addresses

Primary practice location

242 Mason Ave
Suite 1
Staten Island, NY 10305-3408

Mailing address

242 Mason Ave
Suite 1
Staten Island, NY 10305-3408
Phone (718) 226-6221

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
I20120607000434 NY Practitioner - Pediatric Medicine 7810151651 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
258768NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Affiliate Group of New York PC CurrentSince Mar 1, 2024 Accepting new patients
Physicians of University Hospital, PC CurrentSince Jul 1, 2012 Accepting new patients
North Shore-Lij Medical PC CurrentSince May 1, 2019 Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Jun 11, 2019 Accepting new patients
Physicians of University Hospital, PC CurrentSince Jul 1, 2012 Accepting new patients
North Shore - Lij Medical PC CurrentSince May 1, 2019 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Locations

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

300 Community Dr
Manhasset, NY 11030

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

1 Edgewater St
Fl 6
Staten Island, NY 10305
Phone (718) 226-1047

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

242 Mason Ave
Ste 1
Staten Island, NY 10305
Phone (718) 226-6262

401 Seaview Ave
Lowr
Staten Island, NY 10305
Phone (718) 226-6186

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

57 Bay St
Staten Island, NY 10301
Phone (718) 226-3200

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326326400000",
    "number": "1417254160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 MASON AVE",
            "address_2": "SUITE 1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053408",
            "telephone_number": "718-226-6221",
            "fax_number": "718-226-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 MASON AVE",
            "address_2": "SUITE 1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053408",
            "telephone_number": "718-226-6221",
            "fax_number": "718-226-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIPOLSKY",
        "first_name": "LYDIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-15",
        "last_updated": "2012-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "258768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.