Individual provider Active NPI

Suzanne L. Polivy

  • Midwife
  • Brooklyn, NY
National Provider Identifier
1710278072
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
F002170 Issued in NY
Practice address
4802 10TH Ave
Brooklyn, NY 11219-2916
Phone
(718) 283-6813
NPI assigned
Apr 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Midwife 176B00000X F002170 NY Primary

Addresses

Primary practice location

4802 10TH Ave
Brooklyn, NY 11219-2916

Mailing address

967 48TH St
Brooklyn, NY 11219-2919
Phone (718) 283-6813

Other practice location 1

368 Fell St
San Francisco, CA 94102-5144
Phone (415) 861-0828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
F002170NYMDMidwife

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Medical Center MMC Midwifery Midwife CurrentSince Sep 20, 2022 Accepting new patients
Maimonides Faculty Practice Plan CurrentSince Sep 20, 2022 Accepting new patients
MMC OB-GYN Faculty Practice Plan CurrentSince Sep 20, 2022 Accepting new patients
Planned Parenthood of the Columbia/Willamette, Inc. Past Accepting new patients

Locations

967 48th St
Brooklyn, NY 11219
Phone (718) 283-8864

4508 16th Ave
Brooklyn, NY 11204
Phone (718) 972-8018

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

1616A Voorhies Ave
Brooklyn, NY 11235
Phone (718) 283-8225

6208 4th Ave
Brooklyn, NY 11220
Phone (718) 283-3000

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": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1710278072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 48TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192919",
            "telephone_number": "718-283-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-6813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "368 Fell St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941025144",
            "country_code": "US",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLIVY",
        "first_name": "SUZANNE",
        "middle_name": "L.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-21",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "NY",
            "license": "F002170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.