NPIMap

Individual provider Active NPI

Itzhak C Haimovic, M.D.

  • Clinical Neurophysiology Physician
  • Great Neck, NY
National Provider Identifier
1629075767
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
129650 Issued in NY
Practice address
170 Great Neck Road
Great Neck, NY 11021
Phone
(516) 487-4464
Fax
(516) 487-4950
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology Physician 2084N0600X 129650 NY Primary

Addresses

Primary practice location

170 Great Neck Road
Great Neck, NY 11021

Mailing address

170 Great Neck Road
Great Neck, NY 11021
Phone (516) 487-4464

Other identifiers 1

IdentifierTypeStateIssuer
01008626MedicaidNY

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
I20050504000826 NY Practitioner - Neurology 5698727907 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
New York University School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Services of Kips Bay PCGroup PAC ID 0143635524, 14 clinicians

Practice addresses (Care Compare)

27005 75TH Ave
New Hyde Park, NY 11040-1402
Phone (516) 321-7555

Hospital & facility affiliations

  • VNS of Ny Home Care Chha Home health agency, New York, NY, CCN 337008
  • Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
  • NS/Lij HS Southside Hospital Hospital, Bay Shore, NY, CCN 330043
  • St Francis Hospital - the Heart Center Hospital, Roslyn, NY, CCN 330182
  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
82.67 of 100Reported as individual
Quality
70.66
Improvement activities
40
Cost
81.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
129650NYMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Services of Kips Bay PC CurrentSince Dec 5, 2022 Accepting new patients
Neurological Specialties of Long Island, PLLC CurrentSince Jan 9, 1984 Accepting new patients
Medical Services of Kips Bay PC CurrentSince Dec 5, 2022 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

825 Northern Blvd
Ste 201
Great Neck, NY 11021
Phone (516) 396-7846

170 Great Neck Rd
Spc Of
Great Neck, NY 11021
Phone (516) 487-4464

170 Great Neck Rd
Great Neck, NY 11021
Phone (516) 487-4464

27005 76th Ave
North New Hyde Pk, NY 11040

Organizations & group practices 3

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 12

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1629075767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 GREAT NECK ROAD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11021",
            "telephone_number": "516-487-4464",
            "fax_number": "516-487-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GREAT NECK ROAD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "11021",
            "telephone_number": "516-487-4464",
            "fax_number": "516-487-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIMOVIC",
        "first_name": "ITZHAK",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "NY",
            "license": "129650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01008626",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.