Organization Active NPI

Optimum Health and Wellness

  • Family Medicine Physician
  • Mineola, NY
National Provider Identifier
1427614734
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OPTIMUM HEALTH AND WELLNESS
Practice address
158 Jericho Tpke
Mineola, NY 11501-1701
Phone
(516) 526-6144
Fax
(516) 517-9515
NPI assigned
May 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Authorized official

Name
Monica Dos SantosNPI 1346682739
Title
Owner
Phone
(516) 526-6144

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

158 Jericho Tpke
Mineola, NY 11501-1701

Mailing address

158 Jericho Tpke
Mineola, NY 11501-1701

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200722001633 NY Part B Supplier - Clinic/Group Practice 5496179582 Receives reassigned benefits from 5 practitioners
Practice locations: Mineola, NY; Smithtown, NY

National Provider Directory

National Provider Directory

Locations

158 Jericho Tpke
Mineola, NY 11501
Phone (516) 526-6144

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1427614734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115011701",
            "fax_number": "516-517-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115011701",
            "telephone_number": "516-526-6144",
            "fax_number": "516-517-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "DOS SANTOS",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-526-6144"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.