NPIMap

Organization Active NPI

Metro Physical Medicine PC

  • Specialist
  • Jamaica, NY
National Provider Identifier
1679903413
Registry record updated Nov 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
194218 Issued in NY
Legal business name
METRO PHYSICAL MEDICINE PC
Practice address
10825 Merrick Blvd
Jamaica, NY 11433-2906
Phone
(718) 658-9700
Fax
(718) 658-9703
NPI assigned
Nov 14, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2013

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

Authorized official

Name
Dr. Samuel Theagene, M.D.
Title
Owner
Phone
(718) 658-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 194218 NY Primary

Addresses

Primary practice location

10825 Merrick Blvd
Jamaica, NY 11433-2906

Mailing address

10825 Merrick Blvd
Jamaica, NY 11433-2906
Phone (718) 658-9700

Other identifiers 1

IdentifierTypeStateIssuer
135761803MedicaidNY

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384387200000",
    "number": "1679903413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10825 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332906",
            "telephone_number": "718-658-9700",
            "fax_number": "718-658-9703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10825 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332906",
            "telephone_number": "718-658-9700",
            "fax_number": "718-658-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO PHYSICAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2013-11-14",
        "status": "A",
        "authorized_official_last_name": "THEAGENE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-658-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "194218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135761803",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.