Individual provider Active NPI

Wojciech Bober, D.O.

  • Family Medicine Physician
  • West Islip, NY
National Provider Identifier
1730491838
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
297472 Issued in NY
Practice address
1000 Montauk Hwy
West Islip, NY 11795-4927
Phone
(631) 376-4163
NPI assigned
Jul 6, 2010
Last updated
Dec 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 297472 NY Primary

Addresses

Primary practice location

1000 Montauk Hwy
West Islip, NY 11795-4927

Mailing address

1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (631) 376-4163

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140725002159 NY Practitioner - Emergency Medicine 8628294733 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1995 Nesconset Hwy
Lake Grove, NY 11755-1013
Phone (631) 731-4449

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
297472NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Emergency Medical Services, PC CurrentSince Jul 1, 2014 Accepting new patients
Stony Brook Emergency Physicians, University Faculty Practice Corporat CurrentSince Mar 30, 2018 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Jan 1, 2021 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Jan 1, 2021 Accepting new patients
City Medical of Upper East Side, PLLC Current Accepting new patients

Locations

2248 31st St
Astoria, NY 11105
Phone (718) 267-1333

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

1995 Nesconset Hwy
Lake Grove, NY 11755
Phone (631) 360-2273

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Interoperability endpoints

  • Direct secure messaging: wojciech.bober.1@2983.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1730491838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954927",
            "telephone_number": "631-376-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954927",
            "telephone_number": "631-376-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBER",
        "first_name": "WOJCIECH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-06",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "297472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Islip, NY

Sources for this page

Verify at the official NPI Registry.