Corona Medical of New York LLC
Organization Active NPI Vascular Surgery Physician · Jackson Heights, NY
NPI 1437691920 · NPPES record last updated Dec 6, 2023
Key facts
- NPI
- 1437691920
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- Legal business name
- CORONA MEDICAL OF NEW YORK LLC
- Practice address
- 4004 Forley Street
Jackson Heights, NY 11372 - Phone
- (718) 301-1100
- Fax
- (224) 246-8042
- NPI assigned
- Nov 15, 2016
- Organization subpart
- No
Authorized official
- Name
- Yan Katsnelson, MD
- Title
- Owner
- Phone
- (847) 257-1244
Practitioners 15
-
Michael C Banker, MD
-
Richard Di Fiore, MD
-
Alexander Gart, MD
-
Stephen G Hurst, M.D.
-
Samir Iskhagi, M.D.
-
Gina L. Louie, MD
-
Eugene Palchik, MD
-
Jeromy Ryan Patterson, M.D.
-
Aaron Dov Reichman, M.D.
-
Jacob White, MD
-
Sean Yetman, MD
-
Chaim Israel Fishfeld, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180227000708 | NY | Part B Supplier - Clinic/Group Practice | 5395006746 |
Receives reassigned benefits from 13 practitioners Practice locations: Elmhurst, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | Yes |
Addresses
Primary practice location
4004 Forley Street
Jackson Heights, NY 11372
Mailing address
304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 257-1244
Other providers in Jackson Heights, NY
- Karla Cooper
- Karen Cordoba
- Leoniza Cordoba
- Popi Coritsidis
- Corona Medical Associates
- Claudia Lucia Corona
- Braulio Federico Cosme-Thormann
- Cosmos Total Optometry Care PLLC
- Cosmos Total Optometry Care PLLC
- Carmen L Crespo
All providers in Jackson Heights, NY · Vascular Surgery Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.