NPIMap

Organization Active NPI

Island Kids Pediatrics, P.C.

  • Pediatric Adolescent Medicine Physician
  • Staten Island, NY
National Provider Identifier
1487792024
Registry record updated Aug 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
200270 Issued in NY
Legal business name
ISLAND KIDS PEDIATRICS, P.C.
Practice address
2066 Richmond Avenue
1St Floor
Staten Island, NY 10314-3916
Phone
(718) 982-9001
Fax
(718) 982-9008
NPI assigned
Feb 4, 2007
Last updated
Aug 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2010

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

Authorized official

Name
Mr. Deniz Cereb, M.D.NPI 1538133178
Title
President
Phone
(718) 982-9001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 200270 NY Primary
Primary Care Clinic/Center 261QP2300X 200270 NY

Addresses

Primary practice location

2066 Richmond Avenue
1St Floor
Staten Island, NY 10314-3916

Mailing address

2066 Richmond Avenue
1St Floor
Staten Island, NY 10314-3916
Phone (718) 982-9001

Other identifiers 2

IdentifierTypeStateIssuer
01717335MedicaidNY
03120101MedicaidNY

Other names 1

  • DENIZ CEREB MD PC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1170547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280707200000",
    "number": "1487792024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2066 RICHMOND AVENUE",
            "address_2": "1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143916",
            "telephone_number": "718-982-9001",
            "fax_number": "718-982-9008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2066 RICHMOND AVENUE",
            "address_2": "1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143916",
            "telephone_number": "718-982-9001",
            "fax_number": "718-982-9008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND KIDS PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-04",
        "last_updated": "2010-08-02",
        "status": "A",
        "authorized_official_last_name": "CEREB",
        "authorized_official_first_name": "DENIZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-982-9001",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "200270",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "200270",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01717335",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03120101",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DENIZ CEREB MD PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; 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.