Staten Island Medical of New York, LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

STATEN ISLAND MEDICAL OF NEW YORK, LLC

Practice address

1975 Hylan Blvd Ste C
Staten Island, NY 10306

Phone

(847) 305-3346

Fax

(888) 979-6720

NPI assigned

Mar 4, 2015

Organization subpart

No

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

Authorized official

Name

Yan Katsnelson, MD

Title

Director

Phone

(847) 257-1244

Specialties & licenses 1

Addresses

Tax ID family

Staten Island Medical of New York2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Staten Island Medical of New York LLC

  • Vascular Surgery Physician
  • Staten Island, NY
  • NPI 1669888277
  NPD tax ID

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1669864369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 DUNDEE RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622129",
            "telephone_number": "847-257-1244",
            "fax_number": "224-246-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 HYLAN BLVD STE C",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10306",
            "telephone_number": "847-305-3346",
            "fax_number": "888-979-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND MEDICAL OF NEW YORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "YAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-257-1244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Staten Island Mall Dental, P.C.
• Staten Island Medical & Behavioral PC
• Staten Island Medical Group, PLLC
• Staten Island Medical Intensivist PC
• Staten Island Medical of New York LLC
• Staten Island Medical Practice, P.C.
• Staten Island Medical Professional PC
• Staten Island Medical Rehabilitation, P.C.
• Staten Island Medicine PC
• Staten Island Mental Health Counseling PLLC

• Vascular Surgery Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Vascular Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.