NPIMap

Organization Active NPI

City Medical of Upper East Side, PLLC

  • Urgent Care Clinic/Center
  • Ronkonkoma, NY
National Provider Identifier
1417445784
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
CITY MEDICAL OF UPPER EAST SIDE, PLLC
Practice address
600 Portion Rd
Ronkonkoma, NY 11779-1867
Phone
(631) 471-5900
Fax
(631) 471-5901
NPI assigned
Apr 23, 2018
Organization subpart
Yes
Parent organization
CITY MEDICAL OF UPPER EAST SIDE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Swahili Henry
Title
Director of Payment Solutions
Phone
(908) 988-0428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

600 Portion Rd
Ronkonkoma, NY 11779-1867

Mailing address

1345 Avenue of the Americas FL 8
New York, NY 10105-0018
Phone (908) 588-3635

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101111000052 NY Part B Supplier - Clinic/Group Practice 0648465039 Receives reassigned benefits from 871 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2077607City Medical of Upper East Side PLLC600 Portion Road, Ronkonkoma, NY 11779Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
City Medical of Upper East Side PLLC136 organizations share this tax ID, including this one
Part of
City Medical of Upper East Side PLLC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1417445784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 AVENUE OF THE AMERICAS FL 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101050018",
            "telephone_number": "908-588-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PORTION RD",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117791867",
            "telephone_number": "631-471-5900",
            "fax_number": "631-471-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY MEDICAL OF UPPER EAST SIDE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITY MEDICAL OF UPPER EAST SIDE, PLLC",
        "enumeration_date": "2018-04-23",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "SWAHILI",
        "authorized_official_title_or_position": "DIRECTOR OF PAYMENT SOLUTIONS",
        "authorized_official_telephone_number": "908-988-0428"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.