NPIMap

Organization Active NPI

CS Medical Associates, P.C.

Doing business as Victory Recovery Partners

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Massapequa Park, NY
National Provider Identifier
1619642006
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CS MEDICAL ASSOCIATES, P.C.
Doing business as
Victory Recovery Partners
Practice address
5100 Sunrise Hwy FL 2
Massapequa Park, NY 11762-2935
Phone
(631) 696-4357
NPI assigned
Aug 9, 2021
Last updated
Aug 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CS MEDICAL ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Authorized official

Name
Tracey Wallace
Title
VP Operations
Phone
(631) 696-4357

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Addiction Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083A0300X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

5100 Sunrise Hwy FL 2
Massapequa Park, NY 11762-2935

Mailing address

100 Granny Rd Ste 1
Farmingville, NY 11738-2879
Phone (631) 696-4357

Other names 1

  • Victory Recovery Partners Doing business as

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
33D2232843CS Medical Associates PC5100 Sunrise Hwy, Massapequa Park, NY 11762Certificate of waiverMar 26, 2027
33D2337017CS Medical Associates PC5100 Sunrise Hwy, Massapequa Park, NY 11762Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
CS Medical Associates PC9 organizations share this tax ID, including this one
Part of
CS Medical Associates PC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5100 Sunrise Hwy
Fl 2
Massapequa Park, NY 11762
Phone (516) 205-6714

NPI Registry JSON

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1619642006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GRANNY RD STE 1",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117382879",
            "telephone_number": "631-696-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 SUNRISE HWY FL 2",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117622935",
            "telephone_number": "631-696-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CS MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CS MEDICAL ASSOCIATES, P.C.",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "631-696-4357"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Recovery Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Massapequa Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.