NPIMap

Individual provider Active NPI

Keith Alan Chadwick, MD, MS

  • Otolaryngology Physician
  • Lake Grove, NY
National Provider Identifier
1487091328
Registry record updated Feb 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
294203 Issued in NY
Practice address
4 Smith Haven Mall Ste 200
Lake Grove, NY 11755-1219
Phone
(631) 444-4121
Fax
(631) 444-4189
NPI assigned
Jun 2, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PG168015 OR
Student in an Organized Health Care Education/Training Program 390200000X 0116025714 VA
Otolaryngology Physician 207Y00000X 294203 NY Primary

Addresses

Primary practice location

4 Smith Haven Mall Ste 200
Lake Grove, NY 11755-1219

Mailing address

PO Box 1559
Stony Brook, NY 11790-0989

Other practice location 1

37 Research Way
East Setauket, NY 11733-3465
Phone (631) 444-4545

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Keith.Chadwick@direct.stonybrookmedicine.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180806001529 NY Practitioner - Otolaryngology 3779723432 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Virginia Commonwealth University, School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

255 W Montauk Hwy
Life Care Ctr
Hampton Bays, NY 11946
Phone (631) 723-5000

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux18
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Master of Science

State licenses

LicenseStateTypeSpecialty
PG168015ORMDStudent in an Organized Health Care Education/Training Program
0116025714VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Surgical Associates, University Faculty Practice Corporati CurrentSince Sep 1, 2020 Accepting new patients
Weill Medical College of Cornell Otolaryngology CurrentSince Jul 1, 2018 Accepting new patients
Weill Medical College of Cornell CurrentSince Jul 1, 2018 Accepting new patients
University Hospital at Stony Brook Current Accepting new patients

Locations

4 Smith Haven Mall
Ste 200
Lake Grove, NY 11755
Phone (631) 444-4121

1305 York Ave
#5
New York, NY 10021
Phone (212) 746-2281

240 E 59th St
Fl 2
New York, NY 10022
Phone (212) 421-0473

37 Research Way
Setauket, NY 11733
Phone (631) 444-4121

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: keith.chadwick@direct.stonybrookmedicine.edu

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1370131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771113600000",
    "number": "1487091328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SMITH HAVEN MALL STE 200",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117551219",
            "telephone_number": "631-444-4121",
            "fax_number": "631-444-4189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37 Research Way",
            "address_purpose": "LOCATION",
            "city": "East Setauket",
            "state": "NY",
            "postal_code": "117333465",
            "country_code": "US",
            "telephone_number": "631-444-4545",
            "fax_number": "631-444-4707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHADWICK",
        "first_name": "KEITH",
        "middle_name": "ALAN",
        "credential": "MD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-02",
        "last_updated": "2026-02-15",
        "certification_date": "2026-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": "PG168015",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116025714",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "294203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Keith.Chadwick@direct.stonybrookmedicine.edu",
            "affiliation": "N",
            "address_1": "37 Research Way",
            "city": "East Setauket",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117333465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Grove, NY

Sources for this page

Verify at the official NPI Registry.