NPIMap

Organization Active NPI

Ny Mobile Medical PC

  • Specialist
  • Leesburg, FL
National Provider Identifier
1740865773
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NY MOBILE MEDICAL PC
Practice address
700 N Palmetto St
Leesburg, FL 34748-4419
Phone
(203) 869-5515
Fax
(203) 869-5765
NPI assigned
Mar 11, 2021
Last updated
Mar 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Authorized official

Name
Glenn Gandelman, MDNPI 1033117437
Title
Ceo
Phone
(203) 869-5515

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
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

700 N Palmetto St
Leesburg, FL 34748-4419

Mailing address

65 Broadway Ste 903
New York, NY 10006-2531

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210325001588 FL Part B Supplier - Clinic/Group Practice 1850678053 Receives reassigned benefits from 1 practitioner
Practice locations: Leesburg, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

700 N Palmetto St
Apt 1A
Leesburg, FL 34748

2178 N 5th St
Allegany, NY 14706
Phone (716) 373-2238

287 Baker St
Huntsville, TN 37756
Phone (212) 595-0005

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1740865773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 BROADWAY STE 903",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100062531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N PALMETTO ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347484419",
            "telephone_number": "203-869-5515",
            "fax_number": "203-869-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NY MOBILE MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "GANDELMAN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-869-5515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.