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
Staten Island, NY 10306

Phone

(186) 909-5917

Fax

(224) 235-4652

NPI assigned

Jul 2, 2014

Last updated

May 31, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Flora Katsnelson, MD

Title

Owner

Phone

(847) 257-1244

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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 1669864369
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chaim Israel Fishfeld, D.O.

  • Surgery Physician
  • Inwood, NY
  • NPI 1851454953
  Medicare reassignment Care Compare group NPD
• Stephanie Spano, MD

  • Vascular & Interventional Radiology Physician
  • Bronx, NY
  • NPI 1538515523
  Medicare reassignment Care Compare group NPD
• Glenn Rory Faust, MD

  • Vascular Surgery Physician
  • East Meadow, NY
  • NPI 1003986456
  Medicare reassignment
• Eugene Palchik, MD

  • Vascular Surgery Physician
  • Brooklyn, NY
  • NPI 1760587430
  Medicare reassignment
• Aaron Opher Shiloh, M.D.

  • Vascular & Interventional Radiology Physician
  • Philadelphia, PA
  • NPI 1003886896
  NPD (past)

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

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527724800000",
    "number": "1669888277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063523",
            "telephone_number": "718-301-1100",
            "fax_number": "888-979-6720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10306",
            "telephone_number": "186-909-5917",
            "fax_number": "224-235-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND MEDICAL OF NEW YORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-02",
        "last_updated": "2018-05-31",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-257-1244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 31, 2018; 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.