Active NPI
Gregory Suprin, M.D.
- Family Medicine Physician
- Jamaica, NY
National Provider Identifier
1447207071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 230165
- Practice address
- 8810 Parsons Blvd
Jamaica, NY 11432-3842 - Phone
- (718) 291-8111
- Fax
- (718) 487-9343
- NPI assigned
- May 28, 2006
- Last updated
- Jun 4, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 230165-1 | NY | |
| Family Medicine Physician | 207Q00000X | 230165 | NY | Primary |
Addresses
Primary practice location
8810 Parsons Blvd
Jamaica, NY 11432-3842
Mailing address
111 Broadway
#1005
New York, NY 10006-1951
Phone (646) 217-4610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02585106 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 230165-1 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gregory Suprin MD PLLC | Family Medicine | Past | Accepting new patients |
| Imtiyaz I Kapadwala DPM PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Brooklyn, NY
- NPI 1043428097
-
- Specialist
- Brooklyn, NY
- NPI 1134199599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401840000000",
"number": "1447207071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 BROADWAY",
"address_2": "#1005",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100061951",
"telephone_number": "646-217-4610",
"fax_number": "917-591-8596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8810 PARSONS BLVD",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114323842",
"telephone_number": "718-291-8111",
"fax_number": "718-487-9343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPRIN",
"first_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-28",
"last_updated": "2014-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "230165-1",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "230165",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02585106",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.