NPIMap

Organization Active NPI

Seagate Family Medicine Associates, LLC

  • Family Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1619089091
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SEAGATE FAMILY MEDICINE ASSOCIATES, LLC
Practice address
2064 Cropsey Ave Apt 1G
Brooklyn, NY 11214-6208
Phone
(718) 975-8765
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Edward StolyarNPI 1548236417
Title
President
Phone
(718) 975-8765

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2064 Cropsey Ave Apt 1G
Brooklyn, NY 11214-6208

Mailing address

2064 Cropsey Ave Apt 1G
Brooklyn, NY 11214-6208

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061220000487 NY Part B Supplier - Clinic/Group Practice 2668471624 Receives reassigned benefits from 11 practitioners
Practice locations: Brooklyn, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1052241Seagate Family Medicine Associates2064 Cropsey Avenue, Brooklyn, NY 11214Provider-performed microscopyMar 20, 2028

National Provider Directory

National Provider Directory

Locations

2470 Knapp St
Brooklyn, NY 11235

2064 Cropsey Ave
Ste 1G
Brooklyn, NY 11214
Phone (718) 975-8763

Practitioners & affiliated clinicians

Practitioners 12

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619089091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2064 CROPSEY AVE APT 1G",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112146208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2064 CROPSEY AVE APT 1G",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112146208",
            "telephone_number": "718-975-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAGATE FAMILY MEDICINE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STOLYAR",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-975-8765"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.