Active NPI
Iwona K Mienko, MD
- Pediatrics Physician
- Ridgewood, NY
National Provider Identifier
1609140334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 217951
- Practice address
- 6412 Fresh Pond Rd
Ridgewood, NY 11385-3331 - Phone
- (718) 497-1565
- Fax
- (718) 497-1567
- NPI assigned
- Feb 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 217951 | NY | Primary |
Addresses
Primary practice location
6412 Fresh Pond Rd
Ridgewood, NY 11385-3331
Mailing address
6412 Fresh Pond Rd
Ridgewood, NY 11385-3331
Phone (718) 497-1565
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02105622 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 217951 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| I M Pediatrics PC | Pediatrics | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Ridgewood, NY
- NPI 1669456984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330300800000",
"number": "1609140334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6412 FRESH POND RD",
"city": "RIDGEWOOD",
"state": "NY",
"postal_code": "113853331",
"telephone_number": "718-497-1565",
"fax_number": "718-497-1567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6412 FRESH POND RD",
"city": "RIDGEWOOD",
"state": "NY",
"postal_code": "113853331",
"telephone_number": "718-497-1565",
"fax_number": "718-497-1567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIENKO",
"first_name": "IWONA",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-27",
"last_updated": "2012-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "217951",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02105622",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.