Active NPI
Medex Diagnostic and Treatment Center LLC
- Ambulatory Surgical Clinic/Center
- Forest Hills, NY
National Provider Identifier
1467085969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- MEDEX DIAGNOSTIC AND TREATMENT CENTER LLC
- Practice address
- 11129 Queens Blvd
Forest Hills, NY 11375-5553 - Phone
- (718) 275-8900
- NPI assigned
- Feb 13, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Oleg Aronov
- Title
- Managing Member
- Phone
- (718) 275-8900
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Primary |
Addresses
Primary practice location
11129 Queens Blvd
Forest Hills, NY 11375-5553
Mailing address
11129 Queens Blvd
Forest Hills, NY 11375-5553
Phone (718) 275-8900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201201000020 | NY | Part B Supplier - Ambulatory Surgical Center | 1456336445 | Practice locations: Forest Hills, NY |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Medex Diagnostic and Treatment Center LLC
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Medex Diagnostic and Treatment Center LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Clinical Pathology/Laboratory Medicine Physician
- Forest Hills, NY
- NPI 1083200174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581552000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1601337600000",
"number": "1467085969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11129 QUEENS BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113755553",
"telephone_number": "718-275-8900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11129 QUEENS BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113755553",
"telephone_number": "718-275-8900"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDEX DIAGNOSTIC AND TREATMENT CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-02-13",
"last_updated": "2020-09-29",
"certification_date": "2020-09-29",
"status": "A",
"authorized_official_last_name": "ARONOV",
"authorized_official_first_name": "OLEG",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "718-275-8900"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.