Organization Active NPI

Universal Medical Practice PC

  • Pain Medicine (Anesthesiology) Physician
  • Forest Hills, NY
National Provider Identifier
1760533376
Registry record updated May 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
212687 Issued in NY
Legal business name
UNIVERSAL MEDICAL PRACTICE PC
Practice address
11034 70TH Rd
Forest Hills, NY 11375-3934
Phone
(718) 672-1100
Fax
(718) 672-7770
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2009

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

Authorized official

Name
Dr. Nidia Rosa Carrero, MD
Title
President
Phone
(718) 672-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X 212687 NY Primary

Addresses

Primary practice location

11034 70TH Rd
Forest Hills, NY 11375-3934

Mailing address

PO Box 270
Massapequa Park, NY 11762-0270
Phone (631) 264-2035

Other identifiers 1

IdentifierTypeStateIssuer
02103506MedicaidNY

National Provider Directory

National Provider Directory

Locations

787 Van Siclen Ave
Brooklyn, NY 11207
Phone (347) 390-8727

9001A Roosevelt Ave
#2
Jackson Heights, NY 11372
Phone (718) 505-0030

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1760533376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117620270",
            "telephone_number": "631-264-2035",
            "fax_number": "631-264-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11034 70TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753934",
            "telephone_number": "718-672-1100",
            "fax_number": "718-672-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL MEDICAL PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "CARRERO",
        "authorized_official_first_name": "NIDIA",
        "authorized_official_middle_name": "ROSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-672-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "212687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02103506",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.