Individual provider Active NPI

Maggie Tetrokalashvili, M.D.

  • Obstetrics & Gynecology Physician
  • East Meadow, NY
National Provider Identifier
1619944808
Registry record updated Oct 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
224627-1 Issued in NY
Practice address
2201 Hempstead Tpke
East Meadow, NY 11554-1859
Phone
(516) 572-6254
Fax
(516) 572-3124
NPI assigned
Mar 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 224627-1 NY Primary

Addresses

Primary practice location

2201 Hempstead Tpke
East Meadow, NY 11554-1859

Mailing address

2201 Hempstead Tpke
East Meadow, NY 11554-1859
Phone (516) 572-6254

Other identifiers 1

IdentifierTypeStateIssuer
02660240MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050601000292 NY Practitioner - Obstetrics/Gynecology 4183666092 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

Practice addresses (Care Compare)

2601 Ocean Pkwy
Brooklyn, NY 11235-7745
Phone (718) 616-5356

Hospital & facility affiliations

  • South Brooklyn Health Hospital, Brooklyn, NY, CCN 330196

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
224627NYMDInternal Medicine Physician
224627-1NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nassau Health Care Corporation Current Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Jan 6, 2020 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Mar 1, 2024 Accepting new patients
Nassau Health Care Corporation CurrentSince Apr 26, 2004 Accepting new patients
Nassau Health Care Corporation CurrentSince Apr 26, 2004 Accepting new patients
South Ocean Care LLC Past Accepting new patients
NHCC Medical Faculty Practice Plan PC Past Accepting new patients

Locations

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

2201 Hempstead Tpke
Rm 2448
East Meadow, NY 11554
Phone (516) 572-1234

2201 Hempstead Tpke
East Meadow, NY 11554
Phone (516) 486-6862

2201 Hempstead Tpke
Fl 3
East Meadow, NY 11554
Phone (516) 572-6254

2201 Hempstead Tpke
Fl 19
East Meadow, NY 11554
Phone (516) 486-6862

161 Hempstead Tpke
Elmont, NY 11003
Phone (516) 571-8200

460 N Main St
Freeport, NY 11520
Phone (516) 571-3410

100 Main St
Hempstead, NY 11550
Phone (516) 572-6711

615 Riverside Blvd
Long Beach, NY 11561
Phone (516) 571-7795

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

875 Jerusalem Ave
Uniondale, NY 11553
Phone (516) 572-1400

682 Union Ave
Westbury, NY 11590
Phone (516) 571-9500

Networks

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

Interoperability endpoints

  • Direct secure messaging: mtetrokalashvili1126819@nychhc.direct-ci.com

Organizations & group practices 7

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 1

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": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1619944808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 HEMPSTEAD TPKE",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115541859",
            "telephone_number": "516-572-6254",
            "fax_number": "516-572-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 HEMPSTEAD TPKE",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115541859",
            "telephone_number": "516-572-6254",
            "fax_number": "516-572-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETROKALASHVILI",
        "first_name": "MAGGIE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-07",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "224627-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02660240",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Meadow, NY

Sources for this page

Verify at the official NPI Registry.