Legacy Medical PLLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

199052-1 Issued in NY

Legal business name

LEGACY MEDICAL PLLC

Practice address

3741 77TH St
Jackson HTS, NY 11372-6629

Phone

(718) 406-9588

NPI assigned

Aug 17, 2012

Last updated

Feb 25, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Madhu Boppana, M.D,

Title

Owner

Phone

(646) 270-1050

Specialties & licenses 1

Addresses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/4333/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1457609653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 8TH AVE # 101",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100111607",
            "telephone_number": "646-270-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3741 77TH ST",
            "city": "JACKSON HTS",
            "state": "NY",
            "postal_code": "113726629",
            "telephone_number": "718-406-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-17",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "BOPPANA",
        "authorized_official_first_name": "MADHU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-270-1050",
        "authorized_official_credential": "M.D,"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "199052-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Jackson HTS, NY
• Providers in Jackson HTS, NY by specialty
• Neurology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.