NPIMap

Organization Active NPI

Fresh Meadows Physician Practice PLLC

  • Internal Medicine Physician
  • Jamaica, NY
National Provider Identifier
1720775083
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FRESH MEADOWS PHYSICIAN PRACTICE PLLC
Practice address
9131 175TH St
Jamaica, NY 11432-5517
Phone
(718) 709-0940
NPI assigned
Apr 18, 2023
Last updated
Apr 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Authorized official

Name
Dr. Peyman E Younesi, MDNPI 1891942645
Title
Owner
Phone
(718) 708-0940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9131 175TH St
Jamaica, NY 11432-5517

Mailing address

6136 170TH St Apt M4
Fresh Meadows, NY 11365-1957
Phone (718) 709-0940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231114003265 NY Part B Supplier - Clinic/Group Practice 0941657811 Receives reassigned benefits from 64 practitioners
Practice locations: Elmhurst, NY; Granville, NY; Far Rockaway, NY; Fresh Meadows, NY; Glens Falls, NY; Haverstraw, NY; Le Roy, NY; Maspeth, NY…

National Provider Directory

National Provider Directory

Locations

2160 Saint Paul St
Rochester, NY 14621
Phone (585) 342-5540

Practitioners & affiliated clinicians

Practitioners 80

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.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1720775083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6136 170TH ST APT M4",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651957",
            "telephone_number": "718-709-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9131 175TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325517",
            "telephone_number": "718-709-0940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH MEADOWS PHYSICIAN PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "YOUNESI",
        "authorized_official_first_name": "PEYMAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-708-0940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 18, 2023; 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.