Individual provider Active NPI

Suzanne Burke-McGovern, M.D.

  • Pediatrics Physician
  • Staten Island, NY
National Provider Identifier
1578887261
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
236510-1 Issued in NY
Practice address
475 Seaview Ave
Staten Island, NY 10305-3436
Phone
(718) 226-9360
Fax
(718) 226-1128
NPI assigned
Mar 24, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 236510-1 NY Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Mailing address

1 Edgewater St
6TH Floor
Staten Island, NY 10305-4900
Phone (718) 226-1047

Other identifiers 1

IdentifierTypeStateIssuer
03232368MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100825000000 NY Practitioner - Pediatric Medicine 4284758475 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
236510-1NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians of University Hospital, PC CurrentSince Jun 7, 2010 Accepting new patients
Physicians of University Hospital, PC CurrentSince Jun 7, 2010 Accepting new patients

Locations

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

1 Edgewater St
Fl 6
Staten Island, NY 10305
Phone (718) 226-1047

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283904000000",
    "number": "1578887261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EDGEWATER ST",
            "address_2": "6TH FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054900",
            "telephone_number": "718-226-1047",
            "fax_number": "718-226-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9360",
            "fax_number": "718-226-1128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE-MCGOVERN",
        "first_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-24",
        "last_updated": "2010-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "236510-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03232368",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.