NPIMap

Organization Active NPI

The Light Medical, PC

  • Specialist
  • New York, NY
National Provider Identifier
1619265998
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
221203 Issued in NY
Legal business name
THE LIGHT MEDICAL, PC
Practice address
254 Canal St
Suite 5001
New York, NY 10013-3501
Phone
(212) 287-3384
Fax
(212) 287-0031
NPI assigned
Jul 20, 2011
Last updated
Sep 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

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

Authorized official

Name
Dr. Ashraf Samaan, MDNPI 1437104437
Title
Owner
Phone
(212) 874-3384

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
Specialist 174400000X 221203 NY Primary

Addresses

Primary practice location

254 Canal St
Suite 5001
New York, NY 10013-3501

Mailing address

15 Leonello Lane
Staten Island, NY 10307-0000
Phone (212) 287-3384

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110829000400 NY Part B Supplier - Clinic/Group Practice 5496925505 Receives reassigned benefits from 11 practitioners
Practice locations: Bronx, NY; Flushing, NY; Springfield Gardens, NY; West Nyack, NY

National Provider Directory

National Provider Directory

Locations

2063 Bartow Ave
Ste A
Bronx, NY 10475
Phone (718) 379-8800

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1619265998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LEONELLO LANE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103070000",
            "telephone_number": "212-287-3384",
            "fax_number": "212-287-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 CANAL ST",
            "address_2": "SUITE 5001",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100133501",
            "telephone_number": "212-287-3384",
            "fax_number": "212-287-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIGHT MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "SAMAAN",
        "authorized_official_first_name": "ASHRAF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-874-3384",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "221203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.