Individual provider Active NPI

Maciej Domek, MD

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1598796013
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
233424 Issued in NY
Practice address
1470 Madison Ave
Mount Sinai Hospital - General Internal Medicine
New York, NY 10029
Phone
(212) 659-8551
Fax
(212) 831-8116
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 233424 NY Primary

Addresses

Primary practice location

1470 Madison Ave
Mount Sinai Hospital - General Internal Medicine
New York, NY 10029

Mailing address

1 Gustave L Levy Place - Box 300
Mount Sinai Department of Medicine
New York, NY 10029
Phone (212) 987-3100

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
I20051109000445 NY Practitioner - HospitalistPractitioner - Internal Medicine 8022036995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

17 E 102ND St
New York, NY 10029-5204
Phone (212) 659-8551

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
233424NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Internal Medicine CurrentSince Aug 1, 2012 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 1, 2012 Accepting new patients
Mount Sinai Hospital Past Accepting new patients
Mount Sinai Diagnostic and Treatment Center Past Accepting new patients

Locations

1470 Madison Ave
New York, NY 10029
Phone (212) 241-0806

17 E 102nd St
New York, NY 10029
Phone (212) 241-7968

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

Networks

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

Organizations & group practices 5

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598796013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PLACE - BOX 300",
            "address_2": "MOUNT SINAI DEPARTMENT OF MEDICINE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10029",
            "telephone_number": "212-987-3100",
            "fax_number": "212-731-5210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 MADISON AVE",
            "address_2": "MOUNT SINAI HOSPITAL - GENERAL INTERNAL MEDICINE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10029",
            "telephone_number": "212-659-8551",
            "fax_number": "212-831-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMEK",
        "first_name": "MACIEJ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "233424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.