NPIMap

Individual provider Active NPI

Marco Bustamante, MD

  • Internal Medicine Physician
  • Long Island City, NY
National Provider Identifier
1700829108
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
227248 Issued in NY
Practice address
2510 30TH Ave
Long Island City, NY 11102-2448
Phone
(718) 267-4245
NPI assigned
Jun 14, 2006
Last updated
Jun 9, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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 227248 NY Primary

Addresses

Primary practice location

2510 30TH Ave
Long Island City, NY 11102-2448

Mailing address

2523 31St Ave
Long Island City, NY 11106-3665
Phone (718) 777-2733

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709000424 NY Practitioner - Family PracticePractitioner - Emergency Medicine 9638157316 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Suffolk Medical PCGroup PAC ID 0244396349, 204 clinicians

Practice addresses (Care Compare)

1000 N Village Ave
Rockville Center, NY 11570-1000
Phone (516) 705-2689

2510 30TH Ave
Astoria, NY 11102-2448
Phone (718) 932-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Mount Sinai Hospital CurrentSince Jan 1, 2000 Accepting new patients
Southwest Suffolk Medical, P.C. CurrentSince Nov 1, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai Internal Medicine CurrentSince Mar 1, 2016 Accepting new patients
Mount Sinai Hospital CurrentSince Jan 1, 2000 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Mar 1, 2016 Accepting new patients
Southwest Suffolk Medical PC CurrentSince Nov 1, 2020 Accepting new patients

Locations

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

2715 30th Ave
Long Island City, NY 11102
Phone (718) 267-4808

10114 Liberty Ave
#13292
Ozone Park, NY 11417
Phone (718) 487-3330

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

Networks

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

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212969600000",
    "number": "1700829108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2523 31ST AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111063665",
            "telephone_number": "718-777-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 30TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111022448",
            "telephone_number": "718-267-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "MARCO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "227248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

Verify at the official NPI Registry.