NPIMap

Organization Active NPI

Medical Services of Kips Bay PC

  • Neurology Physician
  • Great Neck, NY
National Provider Identifier
1669075651
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
MEDICAL SERVICES OF KIPS BAY PC
Practice address
170 Great Neck Rd
Great Neck, NY 11021-3357
Phone
(516) 487-4464
Fax
(516) 487-4980
NPI assigned
Nov 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Mrs. Michele L Cusack
Title
Senior Vice President & Cfo
Phone
(516) 321-6058

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RA0401X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

170 Great Neck Rd
Great Neck, NY 11021-3357

Mailing address

325 E Main St
Patchogue, NY 11772-3114
Phone (516) 358-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210217000628 NY Part B Supplier - Clinic/Group Practice 0143635524 Receives reassigned benefits from 40 practitioners
Practice locations: Huntington, NY; Woodbury, NY; Manhasset, NY; Melville, NY; Mineola, NY; New Hyde Park, NY; New York, NY; Plainview, NY…

National Provider Directory

National Provider Directory

Locations

53 Brentwood Rd
Bay Shore, NY 11706
Phone (516) 487-9454

1001 Franklin Ave
Rm 110
Garden City, NY 11530
Phone (516) 396-7846

325 E Main St
Patchogue, NY 11772
Phone (631) 654-3278

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1669075651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E MAIN ST",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723114",
            "telephone_number": "516-358-8100",
            "fax_number": "631-654-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GREAT NECK RD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110213357",
            "telephone_number": "516-487-4464",
            "fax_number": "516-487-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SERVICES OF KIPS BAY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-20",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.