NPIMap

Organization Active NPI

Mylaurel Medical Group Ny, PLLC

  • General Practice Physician
  • New York, NY
National Provider Identifier
1477214237
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MYLAUREL MEDICAL GROUP NY, PLLC
Practice address
885 3Rd Ave FL 29
New York, NY 10022-4834
Phone
(917) 613-9004
NPI assigned
Jan 4, 2022
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
Branko Kolvek
Title
Coo
Phone
(347) 497-2452

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

885 3Rd Ave FL 29
New York, NY 10022-4834

Mailing address

885 3Rd Ave FL 29
New York, NY 10022-4834
Phone (917) 613-9004

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230214000408 NY Part B Supplier - Clinic/Group Practice 7618349044 Receives reassigned benefits from 29 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

949 48th St
Brooklyn, NY 11219
Phone (702) 417-6255

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1477214237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 3RD AVE FL 29",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100224834",
            "telephone_number": "917-613-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 3RD AVE FL 29",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100224834",
            "telephone_number": "917-613-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYLAUREL MEDICAL GROUP NY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-04",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "KOLVEK",
        "authorized_official_first_name": "BRANKO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "347-497-2452"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.