NPIMap

Organization Active NPI

The Door - a Center of Alternatives, Inc.

  • Pediatric Adolescent Medicine Physician
  • New York, NY
National Provider Identifier
1679620090
Registry record updated Oct 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
118888-1 Issued in NY
Legal business name
THE DOOR - A CENTER OF ALTERNATIVES, INC.
Practice address
121 Avenue of the Americas
New York, NY 10013-1510
Phone
(212) 941-9090
Fax
(212) 941-9614
NPI assigned
Jan 5, 2007
Last updated
Oct 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2017

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

Authorized official

Name
Ms. Renee M McConey, MS
Title
Director of Adolescent Health Servi
Phone
(212) 453-0209

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X 118888-1 NY Primary
Non-Surgical Family Planning Clinic/Center 261QF0050X NY

Addresses

Primary practice location

121 Avenue of the Americas
New York, NY 10013-1510

Mailing address

121 Avenue of the Americas
New York, NY 10013-1510
Phone (212) 941-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180131000753 NY Part A Provider - Federally Qualified Health Center (FQHC) 8022378686 Practice locations: New York, NY
O20181126001336 NY Part B Supplier - Clinic/Group Practice 8022378686 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: New York, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679620090. Details of each certification follow.

Federally qualified health center certification: CCN 571089

Legal name
THE DOOR - A CENTER OF ALTERNATIVES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 7, 2018
Last certification
Feb 7, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 1, 2017 in NY
Enrollment address
555 Broome St
New York, NY 10013-1510

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0704400Door - a Center of Alternatives Inc, the555 Broome Street, New York, NY 10013Provider-performed microscopyMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
The Door - a Center of Alternatives Inc2 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.

Locations

555 Broome St
New York, NY 10013
Phone (212) 453-0222

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Irma Gonzalez Individual Corporate Officer Mar 29, 2010
W-2 Managing Employee Mar 29, 2010

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1679620090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 AVENUE OF THE AMERICAS",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100131510",
            "telephone_number": "212-941-9090",
            "fax_number": "212-941-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 AVENUE OF THE AMERICAS",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100131510",
            "telephone_number": "212-941-9090",
            "fax_number": "212-941-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DOOR - A CENTER OF ALTERNATIVES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "MCCONEY",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF ADOLESCENT HEALTH SERVI",
        "authorized_official_telephone_number": "212-453-0209",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "118888-1",
            "primary": true
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.