NPIMap

Organization Active NPI

Mollick Etra Etra & Cohen

  • Otolaryngology Physician
  • Great Neck, NY
National Provider Identifier
1457432304
Registry record updated Dec 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
128003 Issued in NY
Legal business name
MOLLICK ETRA ETRA & COHEN
Practice address
560 Northern Blvd
Suite 204
Great Neck, NY 11021-5100
Phone
(516) 487-6200
Fax
(516) 487-6329
NPI assigned
Oct 18, 2006
Last updated
Dec 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2009

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

Authorized official

Name
Dr. Richard G. Etra, M.D.NPI 1679558118
Title
M.D.
Phone
(516) 487-6200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207KA0200X 215924 NY
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X 217820 NY
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 128003 NY Primary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 127393 NY
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 125573 NY
Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YS0123X 207896 NY

Addresses

Primary practice location

560 Northern Blvd
Suite 204
Great Neck, NY 11021-5100

Mailing address

560 Northern Blvd
Suite 204
Great Neck, NY 11021-5100
Phone (516) 487-6200

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261094400000",
    "number": "1457432304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD",
            "address_2": "SUITE 204",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "516-487-6200",
            "fax_number": "516-487-6329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD",
            "address_2": "SUITE 204",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "516-487-6200",
            "fax_number": "516-487-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLLICK ETRA ETRA & COHEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-12-18",
        "status": "A",
        "authorized_official_last_name": "ETRA",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "516-487-6200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "NY",
            "license": "215924",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "217820",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "128003",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "127393",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "125573",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NY",
            "license": "207896",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.