Clove Lakes ENT PC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

CLOVE LAKES ENT PC

Practice address

1414 Victory Blvd
Staten Island, NY 10301

Phone

(718) 447-1261

Fax

(718) 981-1856

NPI assigned

Dec 14, 2006

Last updated

Feb 25, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Helen Hyosun Kim, MDNPI 1063420958

Title

Owner

Phone

(917) 596-7063

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3166/brand/1/csg/1/fhir/r4

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Helen Hyosun Kim, MD

  • Otolaryngology Physician
  • Staten Island, NY
  • NPI 1063420958
  Medicare reassignment NPD Authorized official
• Janet Dellatacoma, PA-C

  • Physician Assistant
  • Staten Island, NY
  • NPI 1306382478
  Medicare reassignment
• Kate Spektor, AUD, CCC-A

  • Audiologist
  • Staten Island, NY
  • NPI 1740205160
  NPD
• Daniele J. Kouroupos, PA-C

  • Physician Assistant
  • Staten Island, NY
  • NPI 1548565856
  NPD (past)
• Dina Masarsky

  • Physician Assistant
  • Staten Island, NY
  • NPI 1427473586
  NPD (past)
• John Mullin, P.A.

  • Physician Assistant
  • Staten Island, NY
  • NPI 1457527095
  NPD (past)
• Santa Upeniece, PA

  • Physician Assistant
  • Staten Island, NY
  • NPI 1114251949
  NPD (past)
• Kenneth Wooh, MD

  • Otolaryngology Physician
  • Staten Island, NY
  • NPI 1306907753
  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614211200000",
    "number": "1619039815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10301",
            "telephone_number": "718-447-1261",
            "fax_number": "718-981-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10301",
            "telephone_number": "718-447-1261",
            "fax_number": "718-981-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVE LAKES ENT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "HELEN",
        "authorized_official_middle_name": "HYOSUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-596-7063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Clifford, CHHA
• Clinical Management Consultants
• Lucia Clohessy, COUNSELOR
• Mary E Clooeny, MSW
• Clove Lake Cars
• Clove Lakes Family Dental PLLC (Oakwood Dental Arts of Clove Lakes)
• Clove Lakes Health Care and Rehabilitation Center, Inc.
• Clove Lakes Rehabilitation and Outpatient Services
• Clove Lakes SNF Operations LLC (Clove Lake Center for Rehabilitation and Nursing)
• Clove RX LLC (Sa Pharmacy)

• Otolaryngology Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Otolaryngology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.