Active NPI
Emma Wallace, MD/PHD
- Vascular Neurology Physician
- Bronx, NY
National Provider Identifier
1558893503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Neurology Physician
- License
- 312463
- Practice address
- 111 E 210TH St
Bronx, NY 10467-2401 - Phone
- (718) 430-3166
- NPI assigned
- Mar 29, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | 312463 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Vascular Neurology Physician | 2084V0102X | 312463 | NY | Primary |
Addresses
Primary practice location
111 E 210TH St
Bronx, NY 10467-2401
Mailing address
43 Westminster Ave
Bergenfield, NJ 07621-3913
Phone (201) 387-1957
Other practice location 1
211 61st St Apt 1
Brooklyn, NY 11220-3782
Phone (718) 630-1270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- State University of New York Downstate Medical Center, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
211 61St St
Apt 1
Brooklyn, NY 11220-3782
Phone (718) 630-1270
43 Westminster Ave
Bergenfield, NJ 07621-3913
Phone (201) 387-1957
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 312463 | NY | MD | Vascular & Interventional Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey Farkas MD LLC | Vascular & Interventional Radiology | Current | Accepting new patients |
Locations
30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066
150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185
Interoperability endpoints
- ewallace510157@nyumc.direct-ci.com
Organizations & group practices 1
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.
-
- Vascular & Interventional Radiology Physician
- East Hills, NY
- NPI 1114267929
NJ
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Staten Island, NY
- NPI 1740389154
-
- General Acute Care Hospital
- Jersey City, NJ
- NPI 1689744856
-
- General Acute Care Hospital
- Denville, NJ
- NPI 1598144362
-
- General Acute Care Hospital
- Newark, NJ
- NPI 1568825545
-
- General Acute Care Hospital
- Passaic, NJ
- NPI 1770901761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649635200000",
"number": "1558893503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 WESTMINSTER AVE",
"city": "BERGENFIELD",
"state": "NJ",
"postal_code": "076213913",
"telephone_number": "201-387-1957",
"fax_number": "201-351-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401",
"telephone_number": "718-430-3166"
}
],
"practiceLocations": [
{
"address_1": "211 61st St Apt 1",
"address_purpose": "LOCATION",
"city": "Brooklyn",
"state": "NY",
"postal_code": "112203782",
"country_code": "US",
"telephone_number": "718-630-1270",
"fax_number": "201-351-0656",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "EMMA",
"credential": "MD/PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-29",
"last_updated": "2022-04-11",
"certification_date": "2022-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "NY",
"license": "312463",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084V0102X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Vascular Neurology",
"state": "NY",
"license": "312463",
"primary": true
}
],
"identifiers": [],
"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 Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.