Individual provider Active NPI

John W Kwiatek, MD

  • Internal Medicine Physician
  • Glen Head, NY
National Provider Identifier
1699784611
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
160399 Issued in NY
Practice address
997 Glen Cove Ave
Glen Head, NY 11545
Phone
(516) 676-5617
Fax
(516) 676-7543
NPI assigned
Aug 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 160399 NY Primary

Addresses

Primary practice location

997 Glen Cove Ave
Glen Head, NY 11545

Mailing address

997 Glen Cove Ave
Glen Head, NY 11545
Phone (516) 676-5617

Other identifiers 1

IdentifierTypeStateIssuer
00998572MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1699784611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 GLEN COVE AVE",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "11545",
            "telephone_number": "516-676-5617",
            "fax_number": "516-676-7543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 GLEN COVE AVE",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "11545",
            "telephone_number": "516-676-5617",
            "fax_number": "516-676-7543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWIATEK",
        "first_name": "JOHN",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "160399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00998572",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Head, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; 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.