Individual provider Active NPI

Samara Rachel Skwiersky, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • New York, NY
National Provider Identifier
1750842860
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
317677 Issued in NY
Practice address
111 Broadway FL 2
New York, NY 10006-1995
Phone
(212) 263-9700
NPI assigned
Mar 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 317677 NY Primary

Addresses

Primary practice location

111 Broadway FL 2
New York, NY 10006-1995

Mailing address

111 Broadway FL 2
New York, NY 10006-1995
Phone (212) 263-9700

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
I20240805000387 NY Practitioner - Endocrinology 2365989621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

111 Broadway
FL 2
New York, NY 10006-1995
Phone (212) 263-9701

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

540 Hudson St
NYU Langone Care on Demand W Vill
New York, NY 10014-3233
Phone (646) 754-2200

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

97 Amity St
Brooklyn, NY 11201-6004
Phone (212) 598-6784

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Aug 1, 2024 Accepting new patients
New York University CurrentSince Aug 1, 2024 Accepting new patients

Locations

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

101 Mineola Blvd
Fl 2
Mineola, NY 11501
Phone (516) 633-3511

111 Broadway
Fl 2
Trinity, NY 10006
Phone (212) 263-9700

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: sskwiersky500194@nyumc.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1750842860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BROADWAY FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061995",
            "telephone_number": "212-263-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BROADWAY FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061995",
            "telephone_number": "212-263-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKWIERSKY",
        "first_name": "SAMARA",
        "middle_name": "RACHEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NY",
            "license": "317677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.