NPIMap

Individual provider Active NPI

Mark Gudesblatt, M.D.

  • Neurology Physician
  • Islip, NY
National Provider Identifier
1528030269
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
147227 Issued in NY
Practice address
712 Main St
Islip, NY 11751-3620
Phone
(631) 666-3939
Fax
(631) 666-3994
NPI assigned
Feb 6, 2006
Last updated
Sep 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 147227 NY Primary

Addresses

Primary practice location

712 Main St
Islip, NY 11751-3620

Mailing address

712 Main St
Islip, NY 11751-3620
Phone (631) 666-3939

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
I20070713000474 NY Practitioner - Neurology 5799672721 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

77 Medford Ave
Patchogue, NY 11772-1281
Phone (631) 758-1910

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
147227NYMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jul 1, 2012 Accepting new patients
New York University CurrentSince Nov 6, 2022 Accepting new patients
New York University CurrentSince Nov 6, 2022 Accepting new patients
Brookhaven Memorial Hospital Medical Center, Inc. CurrentSince Feb 25, 2019 Accepting new patients
Brookhaven Memorial Hospital Medical Center, Inc. Current Accepting new patients
North Shore - Lij Medical PC CurrentSince Jul 1, 2012 Accepting new patients
Long Island Community Hospital at NYU Langone Health CurrentSince Feb 25, 2019 Accepting new patients
Joseph Mandelbaum, M.D. and Craig R. Smolow, M.D., P.C. PastSince Jul 1, 1987 Accepting new patients

Locations

280 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 666-3939

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

712 Main St
Islip, NY 11751
Phone (631) 666-3939

1554 Northern Blvd
Manhasset, NY 11030
Phone (516) 390-9242

300 Community Dr
Manhasset, NY 11030

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

77 Route 112
Patchogue, NY 11772
Phone (631) 207-2370

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

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

Interoperability endpoints

  • Direct secure messaging: mgudesblatt504689@nyumc.direct-ci.com

Organizations & group practices 8

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

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1528030269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513620",
            "telephone_number": "631-666-3939",
            "fax_number": "631-666-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513620",
            "telephone_number": "631-666-3939",
            "fax_number": "631-666-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDESBLATT",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "147227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islip, NY

Sources for this page

Verify at the official NPI Registry.