Individual provider Active NPI

Heeseung Kwak

  • Acute Care Nurse Practitioner
  • New York, NY
National Provider Identifier
1609220029
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
F430937-1 Issued in NY
Practice address
10 E 102ND St
New York, NY 10029-6030
Phone
(212) 241-6756
NPI assigned
Apr 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X F430937-1 NY Primary

Addresses

Primary practice location

10 E 102ND St
New York, NY 10029-6030

Mailing address

1 Gustave L Levy PL # 3000
New York, NY 10029-6504

Other practice location 1

1 Gustave L Levy Pl
New York, NY 10029-6504
Phone (212) 241-6756

Other practice location 2

1275 York Ave
MSKCC Critical Care Unit
New York, NY 10065
Phone (360) 561-7470

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
I20161123000065 NY Practitioner - Nurse Practitioner 3476832049 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F430937-1NYMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 1, 2018 Accepting new patients
Memorial Anesthesiology Group CurrentSince Sep 26, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 1, 2018 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

633 3rd Ave
Lbby 3
New York, NY 10017
Phone (848) 225-6000

10 E 102nd St
New York, NY 10029
Phone (212) 241-5656

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

5 E 98th St
Fl 12
New York, NY 10029
Phone (212) 241-8303

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.

NPI Registry JSON

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1609220029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL # 3000",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 E 102ND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296030",
            "telephone_number": "212-241-6756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296504",
            "country_code": "US",
            "telephone_number": "212-241-6756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1275 York Ave",
            "address_2": "MSKCC Critical Care Unit",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10065",
            "country_code": "US",
            "telephone_number": "360-561-7470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "HEESEUNG",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-21",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "F430937-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.