NPIMap

Individual provider Active NPI

Bradley Taylor Fong, MD

  • Anesthesiology Physician
  • New York, NY
National Provider Identifier
1760916670
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
312421 Issued in NY
Practice address
1 Gustave L Levy PL FL 8
New York, NY 10029-6504
Phone
(212) 241-6426
Fax
(212) 876-3906
NPI assigned
Apr 18, 2017
Last updated
Oct 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 312421 NY Primary

Addresses

Primary practice location

1 Gustave L Levy PL FL 8
New York, NY 10029-6504

Mailing address

PO Box 5024
New York, NY 10087-5024
Phone (800) 627-4470

Other practice location 1

NewYork Presbyterian Brooklyn Methodist Hospital
506 6th Street
brooklyn, NY 11215
Phone (718) 780-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211005002976 NY Practitioner - Anesthesiology 6103224191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fpa Hospital BasedGroup PAC ID 4789826694, 423 clinicians

Practice addresses (Care Compare)

2510 30TH Ave
Long Island City, NY 11102-2448
Phone (718) 267-4390

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
312421NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based Current Accepting new patients
Fpa Hospital Based Anesthesiology CurrentSince Nov 1, 2021 Accepting new patients
Fpa Hospital Based CurrentSince Nov 1, 2021 Accepting new patients

Locations

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

Organizations & group practices 3

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

Hospital & facility affiliations 6

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": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1760916670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5024",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100875024",
            "telephone_number": "800-627-4470",
            "fax_number": "412-937-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL FL 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-241-6426",
            "fax_number": "212-876-3906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "NewYork Presbyterian Brooklyn Methodist Hospital",
            "address_2": "506 6th Street",
            "address_purpose": "LOCATION",
            "city": "brooklyn",
            "state": "NY",
            "postal_code": "11215",
            "country_code": "US",
            "telephone_number": "718-780-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "BRADLEY",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "312421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.