NPIMap

Organization Active NPI

Jamaica Queens Professional Medical Services of New York LLC

  • Vascular Surgery Physician
  • Jamaica, NY
National Provider Identifier
1578080966
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
036105104 Issued in IL
Legal business name
JAMAICA QUEENS PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
Practice address
16203 Jamaica Ave Unit 200a
Jamaica, NY 11432
Phone
(718) 301-1100
Fax
(224) 246-8042
NPI assigned
Aug 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Authorized official

Name
Yan Katsnelson, MD
Title
Ceo
Phone
(847) 257-1244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X 036105104 IL Primary

Addresses

Primary practice location

16203 Jamaica Ave Unit 200a
Jamaica, NY 11432

Mailing address

304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 257-1244

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180605000934 NY Part B Supplier - Clinic/Group Practice 0042575557 Receives reassigned benefits from 18 practitioners
Practice locations: Jamaica, NY

National Provider Directory

National Provider Directory

Locations

16203 Jamaica Ave
Unit 200A
Jamaica, NY 11432
Phone (347) 390-1075

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1578080966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WAINWRIGHT DR",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621900",
            "telephone_number": "847-257-1244",
            "fax_number": "224-246-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16203 JAMAICA AVE UNIT 200A",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "11432",
            "telephone_number": "718-301-1100",
            "fax_number": "224-246-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMAICA QUEENS PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "YAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-257-1244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036105104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; 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.