Individual provider Active NPI

Samuel G Nodelman, M.D.

  • Otolaryngology Physician
  • Brooklyn, NY
National Provider Identifier
1619070083
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
152116 Issued in NY
Practice address
147A W End Ave
Brooklyn, NY 11235-4808
Phone
(718) 891-5251
Fax
(718) 891-7383
NPI assigned
Sep 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 152116 NY Primary

Addresses

Primary practice location

147A W End Ave
Brooklyn, NY 11235-4808

Mailing address

147A W End Ave
Brooklyn, NY 11235-4808
Phone (718) 891-5251

Other identifiers 1

IdentifierTypeStateIssuer
00780887MedicaidNY

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)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Samuel G Nodelman MD PC CurrentSince Sep 1, 1987 Accepting new patients

Locations

147A W End Ave
Brooklyn, NY 11235
Phone (718) 891-5152

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.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1619070083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147A W END AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112354808",
            "telephone_number": "718-891-5251",
            "fax_number": "718-891-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147A W END AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112354808",
            "telephone_number": "718-891-5251",
            "fax_number": "718-891-7383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NODELMAN",
        "first_name": "SAMUEL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "152116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00780887",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.