Branch Pediatrics and Adolescent Group P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

135693 Issued in NY

Legal business name

BRANCH PEDIATRICS AND ADOLESCENT GROUP P.C.

Practice address

300 E Main St
Suite 4/5
Smithtown, NY 11787-2900

Phone

(631) 979-6466

Fax

(631) 979-6475

NPI assigned

Feb 2, 2012

Last updated

Feb 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Richard C Ancona, MDNPI 1275590697

Title

President

Phone

(631) 979-6466

Specialties & licenses 1

Addresses

Other identifiers 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Richard C Ancona, MD

  • Pediatrics Physician
  • Smithtown, NY
  • NPI 1275590697
  Authorized official Same address or phone

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1740552942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MAIN ST",
            "address_2": "SUITE 4/5",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872900",
            "telephone_number": "631-979-6466",
            "fax_number": "631-979-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E MAIN ST",
            "address_2": "SUITE 4/5",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872900",
            "telephone_number": "631-979-6466",
            "fax_number": "631-979-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANCH PEDIATRICS AND ADOLESCENT GROUP P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "ANCONA",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-979-6466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "135693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2696288",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2837205",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0121165",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Peter Bozek, D.O.
• Bracha Fishman (Eden Health Mental Wellness)
• Kimberly Brady-Marder
• Robert James Brancale, PHARMD
• Branch Medical Associates, P.C.
• Robert Donald Branch Jr., PA
• Ronald Braun, DDS
• Jillian Braverman
• Keith Breglio, M.D.
• Dara Gail Brener, MD

• Pediatrics Physician in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.