Excelsior Integrated Medical Group, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

203601 Issued in NY

Legal business name

EXCELSIOR INTEGRATED MEDICAL GROUP, PLLC

Practice address

217 Grand St
Suite 401
New York, NY 10013-4396

Phone

(212) 390-1830

Fax

(212) 390-8177

NPI assigned

Sep 6, 2013

Last updated

Feb 3, 2016By 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

George Hall, M.D.

Title

President

Phone

(212) 335-0328

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 7

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.

• Simon Zaw Moe Thein, M.B.,B.S.

  • Cardiovascular Disease Physician
  • Brooklyn, NY
  • NPI 1740501055
  Medicare reassignment NPD
• Howard Xu, FNP

  • Family Nurse Practitioner
  • Flushing, NY
  • NPI 1609341890
  Medicare reassignment NPD
• James Cai

  • Physician Assistant
  • Edison, NJ
  • NPI 1215331152

  NY

  Medicare reassignment
• PO Chan, N.P.

  • Adult Health Nurse Practitioner
  • Brooklyn, NY
  • NPI 1225641459
  NPD (past)
• Xian Cheung, DO

  • Family Medicine Physician
  • Flushing, NY
  • NPI 1508358755
  NPD (past)
• Jing Hao Du, MD

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1639756786
  NPD (past)
• Huihui Shi, AGNP-C

  • Adult Health Nurse Practitioner
  • Flushing, NY
  • NPI 1871371526
  NPD (past)

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

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454457600000",
    "number": "1689009854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 GRAND ST",
            "address_2": "SUITE 401",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134396",
            "telephone_number": "212-390-1830",
            "fax_number": "212-390-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 GRAND ST",
            "address_2": "SUITE 401",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134396",
            "telephone_number": "212-390-1830",
            "fax_number": "212-390-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR INTEGRATED MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-06",
        "last_updated": "2016-02-03",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-335-0328",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "203601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Excelsior Integrated Medical Group
• Excelsior Physical Therapy, PC
• Exceptional Individual Services Corp. (Benny)
• Exceptional Medicine and Surgery PC
• Exceptional Wellness of New York Incorporated
• Exclusive Dental Studios (Madison Avenue Dental Associates)

• Specialist in New York, NY
• Providers in New York, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; 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.