Organization Active NPI

Jis Medical Office PC

  • Internal Medicine Physician
  • Elmhurst, NY
National Provider Identifier
1619070927
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
196255 Issued in NY
Legal business name
JIS MEDICAL OFFICE PC
Practice address
40-32 Forley St
1 FL
Elmhurst, NY 11373
Phone
(718) 779-1479
Fax
(718) 779-9246
NPI assigned
Sep 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

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

Authorized official

Name
Mrs. Janet Isabel Sanchez, MDNPI 1962546499
Title
President
Phone
(718) 779-1479

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 196255 NY Primary

Addresses

Primary practice location

40-32 Forley St
1 FL
Elmhurst, NY 11373

Mailing address

40-32 Forley St
1 FL
Elmhurst, NY 11373
Phone (718) 779-1479

Other identifiers 1

IdentifierTypeStateIssuer
01507253MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051219000163 NY Part B Supplier - Clinic/Group Practice 6608897657 Receives reassigned benefits from 1 practitioner
Practice locations: Elmhurst, NY

National Provider Directory

National Provider Directory

Locations

4032 Forley St
#1
Elmhurst, NY 11373
Phone (718) 779-1479

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1619070927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40-32 FORLEY ST",
            "address_2": "1 FL",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "11373",
            "telephone_number": "718-779-1479",
            "fax_number": "718-779-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40-32 FORLEY ST",
            "address_2": "1 FL",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "11373",
            "telephone_number": "718-779-1479",
            "fax_number": "718-779-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIS MEDICAL OFFICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "SANCHEZ",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "ISABEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-779-1479",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01507253",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; 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.