NPIMap

Individual provider Active NPI

Nolyn C Nyatanga, DO

  • Medical Oncology Physician
  • Valley Stream, NY
National Provider Identifier
1518101708
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
2015010241 Issued in MO
Practice address
260 W Sunrise Hwy
Valley Stream, NY 11581-1011
Phone
(718) 732-4049
Fax
(631) 751-0506
NPI assigned
May 1, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 2015010241 MO Primary

Addresses

Primary practice location

260 W Sunrise Hwy
Valley Stream, NY 11581-1011

Mailing address

1500 Route 112 Ste 101
Port Jefferson Station, NY 11776-8054
Phone (631) 751-3000

Other identifiers 1

IdentifierTypeStateIssuer
03906787MedicaidNY

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
I20210813002644 NY Practitioner - Hematology/Oncology 2163736778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Kansas City University of Physicians and Surgeons, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore Hematology Oncology Associates PCGroup PAC ID 1456243641, 474 clinicians

Practice addresses (Care Compare)

1 Delaware Dr
Suite 101
New Hyde Park, NY 11042-1116
Phone (631) 751-3000

1061 N Broadway
Suite 2
North Massapequa, NY 11758-1853
Phone (631) 751-3000

3016 30TH Dr
Astoria, NY 11102-1874
Phone (631) 751-3000

48 Route 25a
Smithtown, NY 11787-1431
Phone (631) 751-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Hematology Oncology Associates PC CurrentSince May 8, 2021 Accepting new patients
North Shore Hematology Oncology Associates PC Past Accepting new patients

Locations

1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354

1500 Route 112
Ste 101
Port Jefferson Station, NY 11776

50 N Park Ave
Rockville Centre, NY 11570

50 N Park Ave
Fl 2
Rockville Centre, NY 11570

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

260 W Sunrise Hwy
Fl 3
Valley Stream, NY 11581
Phone (516) 336-5255

260 W Sunrise Hwy
Valley Stream, NY 11581
Phone (516) 791-4600

Networks

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

Organizations & group practices 2

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 11

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": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1518101708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 STE 101",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768054",
            "telephone_number": "631-751-3000",
            "fax_number": "631-751-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 W SUNRISE HWY",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811011",
            "telephone_number": "718-732-4049",
            "fax_number": "631-751-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYATANGA",
        "first_name": "NOLYN",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-01",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MO",
            "license": "2015010241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03906787",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

Verify at the official NPI Registry.