Organization Active NPI

Adam T. Nomberg, M.D, P.C.

  • Ophthalmology Physician
  • Plainview, NY
National Provider Identifier
1467595397
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
197495 Issued in NY
Legal business name
ADAM T. NOMBERG, M.D, P.C.
Practice address
100 Manetto Hill Rd
Suite 105
Plainview, NY 11803-1311
Phone
(516) 935-4141
Fax
(516) 935-1770
NPI assigned
Feb 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Susan Conway
Title
Billing Manager
Phone
(516) 935-4141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 197495 NY Primary

Addresses

Primary practice location

100 Manetto Hill Rd
Suite 105
Plainview, NY 11803-1311

Mailing address

100 Manetto Hill Rd
Suite 105
Plainview, NY 11803-1311
Phone (516) 935-4141

Other identifiers 1

IdentifierTypeStateIssuer
01753828MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050518000789 NY Part B Supplier - Clinic/Group Practice 9638110851 Receives reassigned benefits from 2 practitioners
Practice locations: Plainview, NY; Port Jefferson Station, NY

National Provider Directory

National Provider Directory

Locations

100 Manetto Hill Rd
Ste 105
Plainview, NY 11803
Phone (516) 752-8866

3 Medical Dr
Ste A
Port Jefferson Station, NY 11776
Phone (631) 473-4245

Practitioners & affiliated clinicians

Practitioners 5

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467595397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MANETTO HILL RD",
            "address_2": "SUITE 105",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118031311",
            "telephone_number": "516-935-4141",
            "fax_number": "516-935-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MANETTO HILL RD",
            "address_2": "SUITE 105",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118031311",
            "telephone_number": "516-935-4141",
            "fax_number": "516-935-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAM T. NOMBERG, M.D, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONWAY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "516-935-4141",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "197495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01753828",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainview, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.