NPIMap

Individual provider Active NPI

Paul A Thodiyil, M.D., FRCS, FACS

  • Surgery Physician
  • Brooklyn, NY
National Provider Identifier
1619104502
Registry record updated Nov 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
253077 Issued in NY
Practice address
9920 4TH Ave
Suite 210
Brooklyn, NY 11209-8333
Phone
(718) 836-4258
Fax
(718) 836-4340
NPI assigned
Jun 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 253077 NY Primary

Addresses

Primary practice location

9920 4TH Ave
Suite 210
Brooklyn, NY 11209-8333

Mailing address

9920 4TH Ave
Suite 210
Brooklyn, NY 11209-8333
Phone (718) 836-4258

Other identifiers 1

IdentifierTypeStateIssuer
101167192MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090803000349 NY Practitioner - General Surgery 6608869243 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 241-6500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
253077NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amboy Medical Practice PC Surgery CurrentSince Oct 1, 2016 Accepting new patients
Amboy Medical Practice PC CurrentSince Oct 1, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai Surgery CurrentSince Jan 1, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
St Lukes Roosevelt Hospital Center Past Accepting new patients
Bimc Faculty Practice Surgery Past Accepting new patients

Locations

9920 4th Ave
Ste 210
Brooklyn, NY 11209
Phone (718) 836-4258

506 6th St
Brooklyn, NY 11215
Phone (718) 780-3279

4500 Parsons Blvd
Flushing, NY 11355
Phone (718) 670-5631

10 Nathan D Perlman Pl
New York, NY 10003
Phone (212) 420-2124

1111 Amsterdam Ave
New York, NY 10025
Phone (212) 523-2309

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

10 Union Sq E
Ste 2P
New York, NY 10003
Phone (212) 844-8200

10 Union Sq E
New York, NY 10003
Phone (212) 253-6800

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Organizations & group practices 8

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417132800000",
    "number": "1619104502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9920 4TH AVE",
            "address_2": "SUITE 210",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112098333",
            "telephone_number": "718-836-4258",
            "fax_number": "718-836-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9920 4TH AVE",
            "address_2": "SUITE 210",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112098333",
            "telephone_number": "718-836-4258",
            "fax_number": "718-836-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THODIYIL",
        "first_name": "PAUL",
        "middle_name": "A",
        "credential": "M.D., FRCS, FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-17",
        "last_updated": "2014-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "253077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101167192",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.