NPIMap

Organization Active NPI

Staten Island Physician Practice PC

Doing business as AdvantageCare Physicians

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1568413169
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
STATEN ISLAND PHYSICIAN PRACTICE PC
Doing business as
AdvantageCare Physicians
Practice address
441 9TH Ave
9TH Floor
New York, NY 10001-1623
Phone
(646) 680-2894
NPI assigned
May 16, 2006
Last updated
Dec 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Authorized official

Name
Marlena Simpson, CPMSM
Title
Avp - Credentialing
Phone
(646) 680-2894

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU
Pediatric Dermatology Physician 207NP0225X NU
Procedural Dermatology Physician 207NS0135X NU
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU
Hematology & Oncology Physician 207RH0003X NU
Ophthalmology Physician 207W00000X NU
Pediatrics Physician 208000000X NU
Diagnostic Radiology Physician 2085R0202X NU
Surgery Physician 208600000X NU
Urology Physician 208800000X NU

Addresses

Primary practice location

441 9TH Ave
9TH Floor
New York, NY 10001-1623

Mailing address

441 9TH Ave
9TH Floor
New York, NY 10001-1623
Phone (646) 680-2894

Other identifiers 1

IdentifierTypeStateIssuer
02769859MedicaidNY

Other names 1

  • AdvantageCare Physicians Doing business as

National Provider Directory

National Provider Directory

Locations

441 9th Ave
New York, NY 10001
Phone (646) 680-1595

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 68

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 68

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1568413169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 9TH AVE",
            "address_2": "9TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100011623",
            "telephone_number": "646-680-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 9TH AVE",
            "address_2": "9TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100011623",
            "telephone_number": "646-680-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND PHYSICIAN PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "MARLENA",
        "authorized_official_title_or_position": "AVP - CREDENTIALING",
        "authorized_official_telephone_number": "646-680-2894",
        "authorized_official_credential": "CPMSM"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02769859",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdvantageCare Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.