NPIMap

Organization Active NPI

New York Diabetes and Endocrinology PLLC

  • Internal Medicine Physician
  • Queens Village, NY
National Provider Identifier
1679003222
Registry record updated Jun 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
253659 Issued in NY
Legal business name
NEW YORK DIABETES AND ENDOCRINOLOGY PLLC
Practice address
20801 Hillside Ave
Queens Village, NY 11427-1711
Phone
(917) 502-0617
NPI assigned
Jun 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2017

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

Authorized official

Name
Sajid KhanNPI 1295975704
Title
MD
Phone
(917) 502-0617

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 253659 NY Primary

Addresses

Primary practice location

20801 Hillside Ave
Queens Village, NY 11427-1711

Mailing address

PO Box 3609
New Hyde Park, NY 11040-8609
Phone (917) 502-0617

Other identifiers 1

IdentifierTypeStateIssuer
03510703MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170926000349 NY Part B Supplier - Clinic/Group Practice 3678847936 Receives reassigned benefits from 6 practitioners
Practice locations: Manhasset, NY; New Hyde Park, NY; Queens Village, NY; Rego Park, NY; Roslyn, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497484800000",
    "number": "1679003222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3609",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110408609",
            "telephone_number": "917-502-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20801 HILLSIDE AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271711",
            "telephone_number": "917-502-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK DIABETES AND ENDOCRINOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2017-06-15",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SAJID",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "917-502-0617"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "253659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03510703",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queens Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; 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.