Individual provider Active NPI

Laura Polizzi, M.D

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1679867022
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
261311-1 Issued in NY
Practice address
110 4TH Ave
Brooklyn, NY 11217-2787
Phone
(718) 369-0817
NPI assigned
Jun 2, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 261311-1 NY Primary

Addresses

Primary practice location

110 4TH Ave
Brooklyn, NY 11217-2787

Mailing address

110 4TH Ave
Brooklyn, NY 11217-2787
Phone (718) 369-0817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160127001293 NY Practitioner - Pediatric Medicine 2860795754 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
261311-1NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Pediatrics CurrentSince Nov 14, 2015 Accepting new patients
Montefiore Medical Center CurrentSince Nov 14, 2015 Accepting new patients
Optum Medical Care, P.C. CurrentSince May 13, 2019 Accepting new patients
Optum Medical Care, P.C. CurrentSince May 13, 2019 Accepting new patients

Locations

192 Route 117 by Pass Rd
Bedford Hills, NY 10507
Phone (914) 232-3135

111 E 210th St
Bronx, NY 10467

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

Philadelphia, PA 19195

Networks

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

Organizations & group practices 4

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": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1679867022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 4TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112172787",
            "telephone_number": "718-369-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 4TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112172787",
            "telephone_number": "718-369-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLIZZI",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "261311-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.