Individual provider Active NPI

Bryan Jonathan Cordero, AGNP

  • Adult Health Nurse Practitioner
  • Cedarhurst, NY
National Provider Identifier
1588444764
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
311532 Issued in NY
Practice address
650 Central Ave Ste K
Cedarhurst, NY 11516-2301
Phone
(516) 804-8590
NPI assigned
Oct 4, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 311532 NY Primary

Addresses

Primary practice location

650 Central Ave Ste K
Cedarhurst, NY 11516-2301

Mailing address

1 Cortelyou St W
Huntington Station, NY 11746-3306
Phone (646) 248-3218

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241121001759 NY Practitioner - Nurse Practitioner 3375078835 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

156 William St
New York, NY 10038-2612
Phone (212) 312-5930

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell CurrentSince Nov 1, 2024 Accepting new patients
Weill Medical College of Cornell CurrentSince Nov 1, 2024 Accepting new patients
Cornell University Medical College Past Accepting new patients

Locations

1305 York Ave
Fl 8
New York, NY 10021
Phone (646) 962-3176

520 E 70th St
Rm ST4
New York, NY 10021
Phone (212) 746-2150

520 E 70th St
#4
New York, NY 10021
Phone (212) 746-2150

156 William St
New York, NY 10038
Phone (646) 962-4679

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1588444764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CORTELYOU ST W",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117463306",
            "telephone_number": "646-248-3218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 CENTRAL AVE STE K",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115162301",
            "telephone_number": "516-804-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDERO",
        "first_name": "BRYAN",
        "middle_name": "JONATHAN",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "311532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedarhurst, NY

Sources for this page

Verify at the official NPI Registry.