Individual provider Active NPI

Sophie Chrisomalis

  • Internal Medicine Physician
  • Jersey City, NJ
National Provider Identifier
1417323882
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
289886 Issued in NY
Practice address
355 Grand St
Jersey City, NJ 07302-4321
Phone
(201) 915-2000
NPI assigned
Aug 19, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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 289886 NY Primary

Addresses

Primary practice location

355 Grand St
Jersey City, NJ 07302-4321

Mailing address

255 Greenwich St
New York, NY 10007-2422
Phone (212) 298-2720

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
I20170929002487 NY Practitioner - Internal Medicine 6002181187 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 W 57TH St
New York, NY 10019-3211
Phone (212) 663-6604

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
289886NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Medical Care PC Internal Medicine CurrentSince Sep 16, 2017 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 15, 2017 Accepting new patients
Icahn School of Medicine at Mount Sinai Internal Medicine CurrentSince Aug 15, 2017 Accepting new patients

Locations

565 Abbott Rd
Rm 8632
Buffalo, NY 14220
Phone (607) 798-5671

55 E 34th St
New York, NY 10016
Phone (212) 252-6131

200 W 57th St
New York, NY 10019
Phone (212) 247-8100

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

160 N Midland Ave
Nyack, NY 10960
Phone (845) 348-2000

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1417323882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 GREENWICH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100072422",
            "telephone_number": "212-298-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 GRAND ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024321",
            "telephone_number": "201-915-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISOMALIS",
        "first_name": "SOPHIE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "289886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.