Queens Nassau Nephrology Services PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

QUEENS NASSAU NEPHROLOGY SERVICES PLLC

Practice address

300 Old Country Road
111
Mineola, NY 11501-4112

Phone

(516) 745-0500

Fax

(516) 745-1534

NPI assigned

Oct 30, 2014

Organization subpart

No

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

Authorized official

Name

Andre Goncharuck, MD

Title

President

Phone

(516) 745-0500

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Queens Nassau Nephrology Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Queens Nassau Nephrology Services PLLC

  • Nephrology Physician
  • Mineola, NY
  • NPI 1992934467
  NPD tax ID

Practitioners 1

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

• Madhusudana R Korrapati, M.D.

  • Nephrology Physician
  • Mineola, NY
  • NPI 1255339834
  NPD

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1770988909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY ROAD",
            "address_2": "111",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014112",
            "telephone_number": "516-745-0500",
            "fax_number": "516-745-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY ROAD",
            "address_2": "111",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014112",
            "telephone_number": "516-745-0500",
            "fax_number": "516-745-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS NASSAU NEPHROLOGY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "GONCHARUCK",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-745-0500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03340883",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Santhosh John Pulickal, RPH
• Joanne Susan Puntillo, RN
• Padmini Purwar, M.D.
• Sherri E Putterman, M.D.
• Michelle Lynn Quale, NP
• Queens Nassau Nephrology Services PLLC
• Queens Nassau Nephrology Services, P.C.
• Ashley Quinn, NP
• Catherine Quinn, C.R.N.P
• Grace Quinn

• Nephrology Physician in Mineola, NY
• Providers in Mineola, NY by specialty
• Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; 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.