Active NPI
Surgein I Fonollosa, LMSW
- Social Worker
- New York, NY
National Provider Identifier
1649964834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 119742
- Practice address
- 290 Lenox Ave FL 3
New York, NY 10027-4991 - Phone
- (212) 663-3000
- NPI assigned
- Jun 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 119742 | NY | Primary |
Addresses
Primary practice location
290 Lenox Ave FL 3
New York, NY 10027-4991
Mailing address
2444 Seymour Ave # 1
Bronx, NY 10469-5722
Phone (347) 571-7672
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119742 | NY | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Bridge, Inc. | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686182400000",
"number": "1649964834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2444 SEYMOUR AVE # 1",
"city": "BRONX",
"state": "NY",
"postal_code": "104695722",
"telephone_number": "347-571-7672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "290 LENOX AVE FL 3",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100274991",
"telephone_number": "212-663-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONOLLOSA",
"first_name": "SURGEIN",
"middle_name": "I",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-08",
"last_updated": "2023-06-08",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"state": "NY",
"license": "119742",
"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 Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.