NPIMap

Organization Active NPI

SJ All Medical PC

  • Clinical Neurophysiology Physician
  • Valley Stream, NY
National Provider Identifier
1750793642
Registry record updated May 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
Legal business name
SJ ALL MEDICAL PC
Practice address
139 N Central Ave
Suite 3
Valley Stream, NY 11580-3856
Phone
(718) 544-4200
Fax
(718) 544-4201
NPI assigned
May 27, 2014
Last updated
May 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2014

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

Authorized official

Name
Ellen Edgar, MDNPI 1326343625
Title
President
Phone
(718) 790-7530

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
Clinical Neurophysiology Physician 2084N0600X NY Primary

Addresses

Primary practice location

139 N Central Ave
Suite 3
Valley Stream, NY 11580-3856

Mailing address

1311 Brightwater Ave Apt 18Ij
Brooklyn, NY 11235-5962
Phone (718) 544-4200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150102000117 NY Part B Supplier - Clinic/Group Practice 9830412642 Receives reassigned benefits from 26 practitioners
Practice locations: Valley Stream, NY

National Provider Directory

National Provider Directory

Locations

125 N Central Ave
Ste A
Valley Stream, NY 11580
Phone (516) 887-8808

139 N Central Ave
Ste 3
Valley Stream, NY 11580
Phone (516) 887-0020

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1750793642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 BRIGHTWATER AVE APT 18IJ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355962",
            "telephone_number": "718-544-4200",
            "fax_number": "718-544-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 N CENTRAL AVE",
            "address_2": "SUITE 3",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115803856",
            "telephone_number": "718-544-4200",
            "fax_number": "718-544-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJ ALL MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "EDGAR",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-790-7530",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; 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.