Active NPI
Miguel Angel Medina, LCSW
- Clinical Social Worker
- Bronx, NY
National Provider Identifier
1497714943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R064077
- Practice address
- 85 W Burnside Ave
Bronx, NY 10453-4015 - Phone
- (718) 483-1270
- Fax
- (718) 228-7471
- NPI assigned
- Mar 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R064077 | NY | Primary |
Addresses
Primary practice location
85 W Burnside Ave
Bronx, NY 10453-4015
Mailing address
85 W Burnside Ave
Bronx, NY 10453-4015
Phone (718) 483-1270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 064077 | Other | NY | LICENSE# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R064077 | NY | MD | Clinical Social Worker |
| 064077 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- miguel.medina.p1@direct.mhhc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282176000000",
"number": "1497714943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 W BURNSIDE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104534015",
"telephone_number": "718-483-1270",
"fax_number": "718-228-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 W BURNSIDE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104534015",
"telephone_number": "718-483-1270",
"fax_number": "718-228-7471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "MIGUEL",
"middle_name": "ANGEL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-22",
"last_updated": "2010-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R064077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE#",
"identifier": "064077",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.