NPIMap

Organization Active NPI

Memorial Pediatric Group

  • Pediatrics Physician
  • New York, NY
National Provider Identifier
1750352381
Registry record updated Sep 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEMORIAL PEDIATRIC GROUP
Practice address
1275 York Ave
New York, NY 10021-6007
Phone
(646) 227-3813
NPI assigned
Jan 31, 2006
Last updated
Sep 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2007

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

Authorized official

Name
Salvatore M Andreozzi
Title
Associate Director
Phone
(646) 227-3751

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Pediatric Hematology & Oncology Physician 2080P0207X NU

Addresses

Primary practice location

1275 York Ave
New York, NY 10021-6007

Mailing address

633 3Rd Ave
Box 3
New York, NY 10017-6706

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000033 NY Part B Supplier - Clinic/Group Practice 1557250958 Receives reassigned benefits from 234 practitioners
Practice locations: Commack, NY; West Harrison, NY; Uniondale, NY; Hauppauge, NY; New York, NY

National Provider Directory

National Provider Directory

Locations

500 Westchester Ave
West Harrison, NY 10604
Phone (914) 367-7000

Practitioners & affiliated clinicians

Practitioners 245

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 245

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1750352381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 3RD AVE",
            "address_2": "BOX 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100216007",
            "telephone_number": "646-227-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL PEDIATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "ANDREOZZI",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "646-227-3751"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; 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.