Individual provider Active NPI

Ellen E Shatzkin, PA

  • Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1669558516
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
004031 Issued in NY
Practice address
MMC - Dept. of Pediatrics
1825 Eastchester Road
Bronx, NY 10461
Phone
(718) 904-4032
NPI assigned
Oct 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 004031 NY Primary

Addresses

Primary practice location

MMC - Dept. of Pediatrics
1825 Eastchester Road
Bronx, NY 10461

Mailing address

53 Beverly Rd
White Plains, NY 10605-3305
Phone (718) 904-4032

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190124003463 NY Practitioner - Physician Assistant 0143567495 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Nov 24, 2018 Accepting new patients
Montefiore Medical Center CurrentSince Nov 24, 2018 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000

111 E 210th St
Bronx, NY 10467

Networks

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669558516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 BEVERLY RD",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106053305",
            "telephone_number": "718-904-4032",
            "fax_number": "718-904-2649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MMC - DEPT. OF PEDIATRICS",
            "address_2": "1825 EASTCHESTER ROAD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10461",
            "telephone_number": "718-904-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATZKIN",
        "first_name": "ELLEN",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "004031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.