NPIMap

Organization Active NPI

Island Wide Medical Care PLLC

  • Dermatology Physician
  • Massapequa, NY
National Provider Identifier
1558049577
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ISLAND WIDE MEDICAL CARE PLLC
Practice address
616 Broadway
Massapequa, NY 11758-5024
Phone
(516) 636-5021
Fax
(516) 636-5023
NPI assigned
Jul 10, 2023
Last updated
Jul 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Authorized official

Name
Frank Suppa, DONPI 1700199213
Title
Owner
Phone
(516) 636-5021

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

616 Broadway
Massapequa, NY 11758-5024

Mailing address

138 Main St # 1009
East Rockaway, NY 11518-1702
Phone (516) 636-5021

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230726002006 NY Part B Supplier - Clinic/Group Practice 1658732458 Receives reassigned benefits from 3 practitioners
Practice locations: Massapequa, NY

National Provider Directory

National Provider Directory

Locations

616 Broadway
Massapequa, NY 11758
Phone (516) 636-5021

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1558049577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 MAIN ST # 1009",
            "city": "EAST ROCKAWAY",
            "state": "NY",
            "postal_code": "115181702",
            "telephone_number": "516-636-5021",
            "fax_number": "516-636-5023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585024",
            "telephone_number": "516-636-5021",
            "fax_number": "516-636-5023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND WIDE MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "SUPPA",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-636-5021",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.