NPIMap

Individual provider Active NPI

Jack Italiano III, DO

  • Sports Medicine (Family Medicine) Physician
  • New Hyde Park, NY
National Provider Identifier
1629606124
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
327932 Issued in NY
Practice address
1999 Marcus Ave Ste 202
New Hyde Park, NY 11042-1021
Phone
(516) 467-8600
Fax
(646) 754-9820
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 327932 NY
Sports Medicine (Family Medicine) Physician 207QS0010X 327932 NY Primary

Addresses

Primary practice location

1999 Marcus Ave Ste 202
New Hyde Park, NY 11042-1021

Mailing address

1999 Marcus Ave Ste 202
New Hyde Park, NY 11042-1021
Phone (516) 467-8600

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
I20240805002222 NY Practitioner - Orthopedic Surgery 1456779750 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
New York College of Osteo Medicine of New York Institute of Technology, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

180 E Pulaski Rd
Huntington Station, NY 11746-1915
Phone (516) 747-8900

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
327932NYMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Aug 1, 2024 Accepting new patients
New York University Orthopaedic Surgery CurrentSince Aug 1, 2024 Accepting new patients
Florida Clinical Practice Association Inc Orthopaedic Surgery PastSince Apr 1, 2020 Accepting new patients

Locations

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

180 Pulaski Rd
Huntington Station, NY 11746
Phone (631) 425-2121

1999 Marcus Ave
Ste 202
New Hyde Park, NY 11042
Phone (516) 467-8600

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Networks

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

Interoperability endpoints

  • Direct secure messaging: jitaliano331320@nyumc.direct-ci.com

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 7

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": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1629606124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE STE 202",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421021",
            "telephone_number": "516-467-8600",
            "fax_number": "646-754-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVE STE 202",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421021",
            "telephone_number": "516-467-8600",
            "fax_number": "646-754-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITALIANO",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "327932",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NY",
            "license": "327932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

Verify at the official NPI Registry.